Fill and Sign the California Wage Form

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address) : TELEPHONE NO.: ––––– ––––– ––––– ––––– ––––– ATTORNEY FOR (Name) : ––––– LEVYING OFFICER (Name and Address) : NAME OF COURT OF COURT, JUDICIAL DISTRICT, OR BRANCH COURT, IF ANY ––––– ––––– PLAINTIFF: ––––– ––––– DEFENDANT: ––––– ––––– APPLICATION FOR EARNINGS WITHHOLDING ORDER (Wage Garnishment) LEVYING OFFICER FILE NO.: ––––– COURT CASE NO.: ––––– TO THE SHERIFF OR ANY MARSHAL OR CONSTABLE OF THE COUNTY OF ––––– OR ANY REGISTERED PROCESS SERVER 1. The judgment creditor (name) : ––––– requests issuance of an Earnings Withholding Order directing the employer to withhold the earnings of the judgment debtor (employee). Name and address of employer Name and address of employee ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– Social Security Number (if known) : ––––– 2. The amounts withheld are to be paid to a. The attorney (or party without an attorney) named at the top of this page. b. Other (name, address, and telephone) : ––––– ––––– ––––– 3. a. Judgment was entered on (date) : ––––– b. Collect the amount directed by the Writ of Execution unless a lesser amount is specified here: $ ––––– 4. The Writ of Execution was issued to collect delinquent amounts payable for the support of a child, former spouse, or spouse of the employee. 5. Special instructions (specify) : ––––– ––––– ––––– 6. (Check a or b) a. I have not previously obtained an order directing this employer to withhold the earnings of this employee. OR  b. I have previously obtained such an order, but that order (check one) : was terminated by a court order, but I am entitled to apply for another Earnings Withholding Order under the provisions of Code of Civil Procedure section 706.105(h). was ineffective. ––––– (TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT) I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: ––––– ––––– (TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT) Form Adopted by the Judicial Council of California WG-001 [Rev. January 1, 2007] APPLICATION FOR EARNINGS WITHHOLDING ORDER (Wage Garnishment) CCP 706.121 electronic form ã 1999-2007 WWW.LawCA.com Law Publishers WG-001