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Claim of Exemption for Wage Garnishment

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CLAIM OF EXEMPTION (Wage Garnishment)

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address):

TELEPHONE NO.:

LEVYING OFFICER (Name and Address):

ATTORNEY FOR (Name):

NAME OF COURT, JUDICIAL DISTRICT, OR BRANCH COURT, IF ANY

PLAINTIFF:

COURT CASE NO.:

DEFENDANT:

LEVYING OFFICER FILE NO.:

-READ THE EMPLOYEE INSTRUCTIONS BEFORE COMPLETING THIS FORM-

Copy all the information required above (except the top left space) from the Earnings Withholding Order. The top left space is for your name or your attorney's name and address. The original and one copy of this form with the Financial Statement attached must be filed with the levying officer. DO NOT FILE WITH THE COURT.

1. I need the following earnings to support myself or my family (check a or b):

a. All earnings.

b. $ each pay period.

2. Please send all papers to

me.

my attorney.

at the address shown above following (specify):

3. I am willing for the following amount to be withheld from my earnings each pay period during the withholding period. I understand that the judgment creditor can accept this offer by not opposing the Claim of Exemption, which will result in the following sum being withheld each pay period (check a or b):

a. None

b. Withhold $ each pay period.

4. I am paid

daily

every two weeks

monthly

weekly

twice a month

other (specify):

NOTE: You must attach a properly completed Financial Statement form to this Claim of Exemption. The Financial Statement form is available without charge from the levying officer.

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-006 [Rev. January 1, 2007]

CLAIM OF EXEMPTION

(Wage Garnishment)

1994-2007

www.pawca.com

Law Publishers

CCP 706.124

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What a Claim of Exemption for Wage Garnishment Is

Claim of Exemption for Wage Garnishment is a formal, written statement used by an employee to assert that some or all of their wages are legally exempt from an existing garnishment. The document identifies the employee, employer, case or docket number, and the legal basis for exemption, and usually requires supporting evidence such as benefit award letters, court orders, or bankruptcy filings. Employers and courts use the claim to pause, reduce, or redirect withholding while the exemption is verified. The form may be filed in paper or electronically where ESIGN and state law permit.

Why Filing an Exemption Claim Matters

Submitting a Claim of Exemption informs employers and creditors that specific wages or benefits may be protected, starts a documented review, and can prevent improper withholding. It helps protect the employee’s basic income and creates a record useful for disputes.

Why Filing an Exemption Claim Matters

Who Prepares, Submits, and Processes These Claims

Common users include employees, payroll staff, and legal representatives handling garnishment matters.

  • Employees — individuals asserting protected income, exemption claims, or requesting withholding adjustments from payroll.
  • Payroll/HR — process claims, verify documentation, and implement withholding changes in the payroll system.
  • Attorneys/legal aid — prepare evidence, file court papers, and advise on statutory exemptions and procedures.

Essential Parts of a Professional Exemption Claim

A complete Claim of Exemption for Wage Garnishment presents clear identification, the legal basis for exemption, supporting documents, and an attestation signed and dated to support consistent processing by employer and court.

Identification

Employee full name, mailing address, employer name, payroll ID, and contact details to match payroll and case records accurately.

Exemption Grounds

Concise legal basis such as public-benefit protections, head-of-household claims, or bankruptcy stay with statutory or docket references where applicable.

Monetary Details

If partial exemption, specify dollar amount or percentage, applicable pay period, and whether exemption applies to gross or net wages.

Supporting Documents

Attach legible court orders, benefit award letters, bankruptcy dockets, or trustee notices; label and reference each attachment in the claim.

Notarization

Include notary block where required by local rule or use Remote Online Notarization (RON) when permitted by the state.

Signature Block

Employee signature and date, plus printed name and optional legal representative signature; include witness lines if jurisdiction requires them.

Step-by-Step: Filing a Claim of Exemption

Follow these core steps to prepare, submit, and track a Claim of Exemption for Wage Garnishment accurately and efficiently.

  • 01
    Gather Documents: Collect pay stubs, benefit letters, court orders, and ID for attachments.
  • 02
    Complete Form: Enter employer, case number, exemption basis, and date in required fields.
  • 03
    Attach Evidence: Attach labeled PDFs of supporting records and ensure legibility.
  • 04
    Submit & Follow: Deliver to payroll or file with the court and keep written confirmation.

How a Claim Moves Through Review and Resolution

This flow describes how a claim progresses from employee submission to employer action and potential court review when disputes arise.

  • Submission: Employee files form with payroll or court.
  • Verification: Employer reviews documents and validates eligibility.
  • Adjustment: Payroll updates withholding pending outcome.
  • Appeal: Court process resolves disputes when documentation is contested.

Recommended Digital Workflow Settings for Processing Claims

Suggested workflow settings help payroll, HR, and legal teams process exemption claims securely and consistently using digital tools.

Field Configuration
Preferred document file format for upload PDF preferred; DOCX acceptable for editable drafts.
Signer authentication method to verify identity Email plus SMS code or employer portal login.
Secure storage location and access controls Encrypted cloud folder with role-based permissions.
Automated notification and routing settings Auto-notify payroll, employee, and legal teams upon receipt.

Platform and Integration Considerations

Use secure eSignature and document storage platforms compatible with payroll systems and local notary rules.

  • File Formats: PDF and DOCX supported.
  • Integrations: Payroll, HR, and case management.
  • Authentication: Email, SMS, and advanced options.

Required Fields You’ll See on the Form

Employee Name: Full legal name required.
Employer Name: Enter legal payroll entity name.
Case Number: Provide court or docket number.
Proof Type: List attached document types.
SSN / TIN: Use last four digits unless instructed.
Signature Date: MM/DD/YYYY format required.

Penalties and Risks of an Incorrect or Fraudulent Claim

False Claim: May trigger perjury penalties.
Continued Garnishment: Garnishment may continue until resolved.
Employer Liability: Employer may be fined for noncompliance.
Payroll Errors: Incorrect entries cause wage miscalculations.
Legal Costs: Attorney fees or court costs possible.
Record Retention: Failure to retain records risks audit.

Common Pitfalls to Avoid When Preparing a Claim

  • Incomplete evidence frequently delays claims; unreadable scans or missing pages force the employer or court to request resubmission, extending garnishment duration.
  • Using inconsistent employer or employee names prevents proper matching to payroll and can result in misapplied payments or rejected claims.
  • Failing to sign or date the form, or using an illegible signature, is a common technical rejection and may require notarization in certain jurisdictions.
  • Submitting the claim to the wrong department or failing to serve the creditor when required will leave the original garnishment order in effect.

Real-World Use Cases and Outcomes

Two typical scenarios show how documentation and filing route affect employer response, payroll adjustments, and possible court involvement.

Public Benefits Recipient

A SNAP recipient with dependent benefits attaches award letters and pay stubs to the claim.

  • Employer suspends withholding during verification period.
  • After review the employer adjusted withholding to exempt the protected benefit portion; the employee kept copies, filed with court when needed, and avoided undue financial hardship while the matter was resolved.

Bankruptcy Stay

An employee in Chapter 13 attaches the trustee notice and bankruptcy docket to assert the automatic stay.

  • Payroll pauses garnishment per provided court documentation.
  • The court order and trustee notice resolved the creditor action; the employer coordinated with the trustee and updated payroll to reflect approved plan payments, preventing duplicate collections.

eSignature Pricing and Feature Comparison for Exemption Claims

Compare starting price, trial availability, bulk send, audit trail, and HIPAA support across common eSignature vendors to evaluate options for digital filing and processing.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial No No Yes, limited Yes, limited
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently Asked Questions About Claims of Exemption

Practical answers to common questions on eligibility, submission, documentation, employer responses, denials, and revocation of exemption claims.


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