COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
: Index No. WG-006
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.:
CLAIM OF EXEMPTION
(Wage Garnishment)
THE PEOPLE OF THE STATE OF NEW YORK
- READ THE EMPLOYEE INSTRUCTIONS BEFORE COMPLETING THIS FORM-
TO
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 filled 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):
GREETINGS:
a. All earnings.
b. each pay all business and excuses being laid aside, you and each of you attend before
$ WE COMMAND YOU, that period.
the Honorable
2. Please send all papers to
at the Court ,
County of located at
me
in room , on the day of , 20 , at o'clock in the noon, and at any recessed
my attorney
or adjourned date, to testify and give evidence as a witness in this action on the part of the
at the address shown above following (specify):
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a each pay penalty of $50 and all damages I under-
3. I am willing for the following amount to be withheld from my earningsmaximumperiod during the withholding period. sustained as a
result of your failure to comply.
stand 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. Witness,
None Honorable , one of the Justices of the
b. Court in
Withhold $ County, day of pay period. , 20
each
4. I am paid
daily every two weeks monthly
(Attorney must sign above and type name below)
weekly twice a month other (specify):
Attorney(s) for
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.
the foregoing is Address
I declare under penalty of perjury under the laws of the State of California thatOffice and P.O.true and correct.
Date:
Telephone No.:
............................................................................. Facsimile No.: (SIGNATURE OF DECLARANT)
(TYPE OR PRINT NAME)
E-Mail Address: Page 1 of 1
Form Adopted by the Judicial Council Code of Civil Procedure, § 706.124
of California CLAIM OF EXEMPTION
Mobile Tel. No.: www.courtinfo.ca.gov
WG-006 [Rev. January 1, 2007]
(Wage Garnishment)
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