note: do not use the above form if you have a chapter 7 bankruptcy case. for example, you may need to pay for copies or pay to have the other side served with court papers. if a statement of inability to afford payment of court costs is approved, you do not have to pay for any costs charged by the court. contact the district clerk’s office in the county where you plan to file your court papers to learn the fees for your case. this form tells the judge you cannot afford to pay the court fees. attachments: if you get government benefits because you are poor, attach proof (such as a copy of an eligibility form or check) to your statement. if you want the judge to consider other facts, such as unusual medical expenses or family emergencies, attach a separate page with that information. the other side may get a copy of this form. if you are worried about the other side knowing your address, you can submit a sworn document that does not list your address instead of this form (see option 2 above). when you sign this form you are stating under penalty of perjury that the information in the form is true and correct.