UNITED STATES COURT OF APPEALS

FOR THE FIFTH CIRCUIT

Court of Appeals Docket Number(s):_________________________________

Short Title:_______________________________________________________

District Court Docket Number(s):___________________________________

REQUEST FOR WAIVER OF MANDATORY FEE REDUCTION

I ______________________________ request a waiver of the mandatory fee reduction based upon:

_____ Illness or other incapacity. The required certification is attached.

_____ Planned vacation. The required certification is attached.

_____ Lengthy or complex litigation or excessive pages ordered. The required certification is attached.

Signature ____________________________________ ______________

Official Court Reporter Date

Signature ____________________________________ ______________

United States District Judge Date

Attach proof of service on all counsel as appropriate.