COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. :
ATTORNEY (Name, State Bar number, and address):
Index No.
FOR COURT USE ONLY
WG-022
: Plaintiff(s) : : : :
Calendar No.keep other people from To
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TELEPHONE NO.: ATTORNEY FOR STATE TAX AGENCY: NAME OF COURT: STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE
-against- NO.: FAX
....... .. ..... APPLICATION. OF .(Name):.
BRANCH NAME:
Defendant(s) : .....................................
TAXPAYER / RESPONDENT
EARNINGS WITHHOLDING ORDER FOR THE PEOPLE OF THE STATE OF NEW YORK TAXES
NAME OF STATE TAX AGENCY:
CASE NUMBER:
TAX AGENCY NUMBER:
TO
1. The State's Application for Earnings Withholding Order for Taxes came on for hearing on (date): in Dept.: Div.: before (name of judicial officer):
Room:
GREETINGS:
2. a. b.
Attorney for state tax agency present in court (name):
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Taxpayer present in court. , the Honorable for taxpayer present in court (name): at the Court Attorney c. located at County of the taxpayer's Claim of Exemption and Financial Declaration 3. The court has considered in room , on the day of , 20 , at o'clock in the noon, and at any recessed the evidence presented the parties' stipulation. or adjourned date, to testify and give evidence as a witness in this action on the part of the
4. THE COURT FINDS a. The taxpayer (employee) is entitled to a monthly exemption of: $ b. The taxpayer is employed by (name and address of employer):
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,has been withheld from the employee's earnings under a Temporary EarningsJustices of the for Taxes. Honorable , one of the Withholding Order 5. THE COURT ORDERS the employer to day of Court in County, , 20
a. withhold and pay to the state tax agency: $ from the employee's disposable earnings each month. per month. b. pay to the employee any disposable earnings above that amount, not to exceed: $ (Attorney must sign above THOSE SET FORTH c. WITHHOLD AND PAY TO THE STATE TAX AGENCY ANY DISPOSABLE EARNINGS ABOVEand type name below) IN ITEMS 4a AND 4b. d. begin withholding with the first pay period that ends on or after the 10th day after this order is served. e. continue withholding until the tax liability has been satisfied unless an order with higher priority is received. Attorney(s) for f. send all sums withheld to the state tax agency within 10 days after the last paycheck of each month. g. other (specify):
c.
Office and P.O. Address
Date:
Form Adopted for Mandatory Use Judicial Council of California WG-022 [Rev. January 1, 2007]
Telephone No.: Facsimile No.: (Instructions to employer on reverse) Address: E-Mail EARNINGS WITHHOLDING ORDER FOR Tel. No.: Mobile TAXES
(Wage Garnishment-State Tax Liability)
JUDICIAL OFFICER Page 1 of 2 Code of Civil Procedure, ยง 706.076 www.courtinfo.ca.gov
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WG-022
APPLICATION OF (Name): TAXPAYER
CASE NUMBER:
/
RESPONDENT
INSTRUCTIONS TO EMPLOYER
A. When remitting withheld sums to the state tax agency, include the employee's name and social security number, and the tax agency number. B. PRIORITY OF EARNINGS WITHHOLDING ORDERS First Order Assigning Salary or Wages : Second: Earnings Withholding Order for Support Third: Earnings Withholding Order for Taxes Fourth: Earnings Withholding Order
WG-022 [Rev January 1, 2007]
EARNINGS WITHHOLDING ORDER FOR TAXES
(Wage Garnishment-State Tax Liability)
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