Unionville, MI · Tuscola County
Request for Partial Waiver of Cost – Indigency Affidavit
This affidavit lets someone requesting Village of Unionville public records ask to suspend the first $20 of fees and costs based on indigency.
What this form is
Use this form when requesting public records from the Village of Unionville and asking the Village to suspend the first $20 of related fees and costs because of indigency. The applicant states whether they receive public assistance and provides benefit details, or explains their inability to pay. The form asks for the date, signature, printed name, and title; the Village may request additional documentation.
Who needs it
A person requesting Village of Unionville public records who is indigent and wants to request suspension of the first $20 in fees and costs should complete this affidavit.
How to submit it
Send the completed form to the Village of Unionville, 6454 Merry St., Unionville, MI 48767. The form lists the Village's phone number as (989) 674-2244.
About notarization
This document has no notary block; the applicant makes a sworn statement under penalties of perjury and signs and dates it, with no notarized attachment identified.
How to submit this form
- 1
Download the Affidavit
Download the Request for Partial Waiver of Cost – Indigency Affidavit.
- 2
Complete the Applicant Details
Select the applicable public assistance option and fill in the requested information or explain why indigency prevents payment.
- 3
Sign and Date the Form
Enter the date, signature, printed name, and title. The Village may request additional documentation.
- 4
Send It to the Village
Send the completed affidavit to the Village of Unionville, 6454 Merry St., Unionville, MI 48767.
Frequently asked questions
- Do I need a notary for the Indigency Affidavit?
- No. The form has no notary block; it asks the applicant to make a sworn statement under penalties of perjury and sign and date it. No notarized attachment is identified.
- Who can use this partial waiver request?
- A person requesting public records from the Village of Unionville who is indigent may use the affidavit to request suspension of the first $20 of fees and costs.
- What information does the affidavit ask for?
- It asks whether you receive public assistance and for benefit and case details, or asks you to explain why indigency prevents you from paying. It also requests a date, signature, printed name, and title.
- How do I submit the Indigency Affidavit?
- Send the completed form to the Village of Unionville at 6454 Merry St., Unionville, MI 48767. The form also lists the Village phone number: (989) 674-2244.