The Judicial Conference has a long-standing policy generally prohibiting the refund of fees upon filing. The authority to approve a refund of other fees generated in error is a judicial determination. The court has determined that the Clerk of Court will address filing fee refund request(s). The Clerk of Court has no authority to refund fees unless an administrative error was made by the Clerk's Office. Please complete the Application and Verification for Refund of Fees. Once completed, please click the Process Request button to forward the form to the Finance Department for processing. Case Information Case No. * YY-XXXXX (YY - year, XXXXX - case number with leading zeros) Case Name * Document No. Payment Information Date of Payment * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202120222023 Receipt Number * Amount * $ Reason Requesting Party Information First Name * Last Name * Address * Address 2 City * State * AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code * Email * Phone * (###-###-#### x####) Attachments Attachment1 Files must be less than 10 MB.Allowed file types: pdf. *Indicates a required field CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.