03/18/2019

Shubham Tripathi
2404 Nutwood Ave
Apt. F10
Fullerton, CA 92831

Sub: Waive first responder fee: Run number 19-95478

Dear Sir/Madam,

I am a student at California State University, Fullerton. I got a mail on Friday (03/15/2019)

stating that I have to pay $275 for "For First Responder Fee." It was regarding an incident on
02/15/2019. But I never used any services. I declined to take any medical facilities or assistant
that day. Even I didn't call for emergency number 911. The reason behind was that I was not
sure that my insurance was working on that day or not as it was supposed to expire and my new
insurance was started from 03/01/2019. As being a student here I don’t work, I pay my education
fee and expanses from my education loan I took in my Country. and I can't afford any services or
assistant on my own without insurance, So I decided to declined to take any services that day, I
never used it. But Now this bill with $275 I got I can't afford it either. Please, I kindly request
you to waive this fee. I not in a state of affording it. As I called in billing inquiries number, they
informed me to write a letter with proving that I am a student so I am enclosing my student status
documents with this letter.

These are the information give on bill:

Run Number: 19-95478
Incident No: F1901838
Date of Service: 02/15/2019

Please contact me at the address given above if you have any questions or need additional
information. I can also be contacted by phone at (714) 251-9597.

Thank you for your assistance,

Sincerely,

Shubham Tripathi