COURT
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Index No.
LEVYING OFFICER (Name and Address)
WG-006
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.:
Calendar No.
Plaintiff(s) -againstATTORNEY FOR (Name): NAME OF COURT, JUDICIAL DISTRICT OR BRANCH COURT, IF ANY:
JUDICIAL SUBPOENA
PLAINTIFF: DEFENDANT: ......
Defendant(s) : ................................................
CLAIM OF EXEMPTION
(Wage Garnishment)
LEVYING OFFICER FILE NO: COURT CASE NO.:
THE PEOPLE OF THE STATE OF NEW YORK
- READ THE EMPLOYEE INSTRUCTIONS BEFORE COMPLETING THIS FORMTO 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. $ WE COMMAND YOU, that period. each pay all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court 2. Please send all papers to located at County of 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 b. at the address shown above following (specify):
the party on whose behalf this subpoena was issued for a each pay penalty of $50 and all damages I under3. I am willing for the following amount to be withheld from my earningsmaximumperiod during the withholding period. sustained 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. b.
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to as a
Witness, None Court in Withhold $
Honorable County,
, one of the Justices of the day of pay period. , 20 each
monthly other (specify):
4. I am paid daily weekly
every two weeks twice a month
(Attorney must sign above and type name below)
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. I declare under penalty of perjury under the laws of the State of California thatOffice and P.O.true and correct. the foregoing is Address Date:
.............................................................................
(TYPE OR PRINT NAME) Form Adopted by the Judicial Council of California WG-006 [Rev. January 1, 2007]
Telephone No.: Facsimile No.: (SIGNATURE OF DECLARANT) Page 1 of 1 E-Mail Address: Code of Civil Procedure, ยง 706.124 CLAIM OF EXEMPTION Mobile Tel. No.: www.courtinfo.ca.gov
(Wage Garnishment)
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