COUNTY . .
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: Index No.
: WG-021
Calendar No.
CONFIDENTIAL
APPLICATION OF (Name): : CASE NUMBER:
Plaintiff(s) JUDICIAL SUBPOENA
-against- TAXPAYER / RESPONDENT
:
CONFIDENTIAL STATEMENT OF TAXPAYER'S
:
SOCIAL SECURITY NUMBER
:
Supplement to Application for Earnings Withholding Order for Taxes (Form WG-020)
(Do not attach to Application)
Defendant(s)
:
......................................................
This separate Confidential Statement of Taxpayer's Social Security Number contains the social
security number of the taxpayer-respondent in the case referenced above. This supplement should
be kept separate from the Application for Earnings Withholding Order for Taxes filed in this case, and
THE PEOPLE OF THE STATE
should not be a public record. OF NEW YORK
TO
INFORMATION ON TAXPAYER-RESPONDENT:
1. Name:
GREETINGS:
2. Social Security Number:
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 TO COURT CLERK
in room , on the THIS STATEMENT IS CONFIDENTIAL. DO NOT in the
day of , 20 , at o'clock FILE noon, and at any recessed
THIS CONFIDENTIAL STATEMENT IN A PUBLIC COURT FILE.
or adjourned date, to testify and give evidence as a witness in this action on the part of the
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 maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Witness, Honorable , one of the Justices of the
Court in County, day of , 20
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Page 1 of 1
Form Adopted for Mandatory Use
Mobile Tel. No.:
Judicial Council of California CONFIDENTIAL SUPPLEMENT TO APPLICATION
WG-021 [Rev. January 1, 2007] FOR EARNINGS WITHHOLDING ORDER FOR TAXES American LegalNet, Inc.
www.FormsWorkflow.com
(Wage Garnishment-State Tax Liability)