COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
: Index No. WG-001
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): TELEPHONE NO.: LEVYING OFFICER (Name and Address):
: Calendar No.
:
Plaintiff(s) JUDICIAL SUBPOENA
-against- :
ATTORNEY FOR (Name):
:
NAME OF COURT, JUDICIAL DISTRICT, OR BRANCH COURT, IF ANY:
:
PLAINTIFF: Defendant(s) :
......................................................
DEFENDANT:
LEVYING OFFICER FILE NO.: COURT CASE NO.:
APPLICATION FOR EARNINGS WITHHOLDING ORDER
STATE OF NEW YORK
THE PEOPLE OF THE (Wage Garnishment)
TO THE SHERIFF OR ANY MARSHAL OR CONSTABLE OF THE COUNTY OF
TO
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).
GREETINGS:
Name and address of employer Name and address of employee
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
the Honorable at the Court ,
County of located at
in room , on the day of , 20 , at o'clock in the noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Social Security Number (if known):
2. The amounts withheld are to be paid to
a. The attorney (or party without an attorney) b. Other (name, address, and telephone):
named at the top of this page.
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose on (date):
3. a. Judgment was entered behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of amount directed by the Writ
b. Collect the your failure to comply. of Execution unless a lesser amount is specified here:
$
4. of Execution was issued , one of child, former spouse,
The Writ Witness, Honorable to collect delinquent amounts payable for the support of athe Justices of the or spouse
of the employee.
Court in County, day of , 20
5. Special instructions (specify):
6. (Check a or b) (Attorney must sign above and type name below)
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):
Attorney(s) for
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.
Office and P.O. Address
(TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY OR PARTY WITHOUT ATTORNEY)
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
Telephone No.:
............................................ Facsimile No.:
(TYPE OR PRINT NAME) E-Mail Address:
(SIGNATURE OF DECLARANT)
Page 1 of 1
Form Adopted by the
Judicial Council of California
Mobile Tel. No.:
APPLICATION FOR EARNINGS WITHHOLDING ORDER Code Civ. Procedure, § 706.121
www.courtinfo.ca.gov
WG-001 [Rev. January 1, 2007] (Wage Garnishment) American LegalNet, Inc.
www.FormsWorkflow.com