Application for ici | exemption from fees — | Fie number jeneral Fienae FeperaLcircuir 9! Are RSGET (not tobe used for divorce) (OF AUSTRALIA. Fri Law (Foe 2012 secbon 208 [Dates (eee Use his form i ‘+ you.ate the primary cathode of a Heath Care Car, Heath Benet Card, Penlter Concession ar, Compare Sirs Hea Caro ry oat sued y Soon of be Depart Citar’ Ata that eres yoo Comrnea heath eoesseors WEBI ese dependant ofthe primary carcheae) ‘you are receiving Legal Ai for your proceeding in the Fada Cet and Feily Court of Australia ‘fom a statetertry egal a fice or approved lagal sd scheme or ovis, + youste an Independent Chien’ Lawyor appoint to represent c's incest prodeedings Linder the Fay Law Act (only exempt fr Subpocna and inter apption les) 1 you are receiving youth allowance or Austudy payment or Abetudy, you are under the age of 18, oF ‘you ae an inmate ofa prison or athorwiselagaly detained in a put nstuon, ‘nen returning your completed application form to the registry you will nee to attach photocopies of, documentary evidence of any of tho above (auch se your Heath Care Cara, Legal Ad latter or Teta {rom the community legal contre advising the Court at May Meet he eva of an approved ‘community legal centre) te support your clalm. Photocopy both sides ofthe carder ater document. Ifyou donot quality for any o the above, you may beable o apply fora fe exemption cn the bas of financial harshp. Ask eich sa forte appropriate form and guceines 'Nyourappicaton for exemption i unsuccessful, you wil be raqured to pay the ful ing ee before your fom vibe aozoptee Warning: Unde: the Criminal Cose any person who knowingly makes an untrue representation © slatement to obtan a benef or advantage rom ie Commonweal gully of an ote ae fond gui. can be {na or mprsoned. ‘Note: Where ther is more than one applicant to an application, a applicants must meet te equerents for an exemption or the fl oe apples. ‘Fee exomptions and reductions only apply fo court fees. GST does not apply to court fees. Name ang | Familyname (sumame}LAZARQU Gi NICHOLAS secs —Eec i agess: Posteode: Telephone 58 clovelly Rd. Randhinele. 593) (ro4ot 667 557) Form epleton C2) Seting down Fee Cito Fut cour Gtinewsing CO earng aivore) Hiner apticaton DResponse 2 Subpoe conection enferonce Ficonsent osers Diiaing apptication (parenting ‘rand VI Vil orders otteron for Gurepty rezave the folowing means-esied panionortberbeneft SSS nh a Pen seeking | [a leath Care Card or rton | F Pensioner Concession Card amin receipt of tesa As Cicommonreatn Series Heath Cars) lama ext under 18 years [Llany or ear issued by Centrink ortho Elam an inmate of prson or tharise Department of Veterans’ fas tht certs — lavfuly tained in s publ ts tromortto Conmomeatt heath" C wdependent chee Layer conoazsion CE aperved commun gal cre D1 Youth allowance or Austudy payment — Clay orate [EiPerson int or lawyer who prepared this application for person in 1 (prin lawyers name) "Name of auyer who prepared his appteation or person 1 Ticopy ofrelevantdccuments—C)Exemplon Exemption sitached ‘anted ratused Sloatue of ooer: Name of fee:ecing a sacl eenty pment oer an Famty Tax Bonet (Hoan Care Cdn) veO oO Card start date | 29/06/2020 Valid from | 2911/2022 | to | 19/tava Customer's card details Name: ieee ee ce fa Residential address: 2 Fem St Centrelink Reference Number: [202 104 960 PaymentCard type: asP. Name of partner: [ae] Centrelink Reference Number: [EEE ‘mation of Concession Card Entitlement [Name of children: ‘The prson what signature appaers blow is Eomcheame eat cmtmers some: | Loh DIqit 123