COURT
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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) -againstATTORNEY FOR (Name): NAME OF COURT, JUDICIAL DISTRICT, OR BRANCH COURT, IF ANY:
JUDICIAL SUBPOENA
PLAINTIFF:
Defendant(s) : ......................................................
LEVYING OFFICER FILE NO.: COURT CASE NO.:
DEFENDANT:
APPLICATION FOR EARNINGS WITHHOLDING ORDER
THE PEOPLE OF THE (Wage Garnishment) STATE OF NEW YORK
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 located at County of 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
2. The amounts withheld are to be paid to a. The attorney (or party without an attorney) named at the top of this page. 3. a. Judgment was entered on (date): the party on whose behalf this $ 4. 5. The Writ of Execution was issued to collect delinquent amounts payable for the support of a the Justices of the or spouse Witness, Honorable , one of child, former spouse, of the employee. Social Security Number (if known): b. Other (name, address, and telephone):
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to subpoena was issued for a maximum penalty of $50 and all damages sustained as a b. Collect the amount directed comply. of Execution unless a lesser amount is specified here: result of your failure to by the Writ
Court in
County,
day of
, 20
Special instructions (specify):
(Attorney must sign above and type name below) 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): 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.
(TYPE OR PRINT NAME)
Office and P.O. Address
(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) (SIGNATURE OF DECLARANT) E-Mail Address: Page 1 of 1 Code Civ. Procedure, ยง 706.121 Form Adopted by the Mobile Tel. No.: APPLICATION FOR EARNINGS WITHHOLDING ORDER www.courtinfo.ca.gov Judicial Council of California
(Wage Garnishment)
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WG-001 [Rev. January 1, 2007]
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