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Name Prison Number Mailing Address, Zip Code, Place of Confinement UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ALASKA PRISONER'S APPLICATION TO WAIVE PREPAYMENT OF FEES Plaintiff, vs. Defendant(s).

If this fee waiver is granted, I may make additional fee applications as desired at any time during the pendency of this action. I understand that I may waive fees if I am awarded partial judgment in my favor on any claim, claim against me, or claim against any person. My request to waive fees may be made at any time during the pendency of this action unless otherwise instructed by the Court. A waiver by me will constitute an admission of the truth of the matter stated by me in support of the waiver, to the exclusion of doubt. I fully understand that I may not file a petition or other pleading unless each individual item is paid by someone else to whom the Court has directed that my fees shall go. THE COURT'S RESPONSIBILITY TO ORDER FEES AND THE FORM TO BE USED IF YOU WISH TO WAIVE FEES I agree that the Court has authorized me to waive all fees and that I understand and agree to the above fees and payment requirements. The Court should be informed before any action in this case is filed that if fees or security are owed by another party, the Plaintiff or Third-Party Defendant may waive those fees and security obligations as required by Federal Rule of Civil Procedure 17(c), and I intend to do so. I understand and agree that when filed, the Fee Application must include the following statement: I, (check the appropriate box), am I certifying that I am a needy applicant and require that this application be processed by this court: FEE APPLICATION; This fee waiver is approved by the Court, and I hereby waive my rights to the payment of fees due under this fee form, as well as any other fees, security or security claims arising from this action except as directed by the Court. I understand and agree to pay the Fees, if the application is approved. By signing this application, I am waiving my right to any further review of this application by any court or agency, and waive the right to challenge the decision to approve this fee application.

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