READ EMPLOYEE INSTRUCTIONS (FORM WG-003)
BEFORE COMPLETING THIS FORM
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 filed with the levying officer.
DO NOT FILE WITH THE COURT.
2. I need the following earnings to support myself or my family (check a or b):
All earnings.a.
each pay period.b. $
3. Please send all papers to
me.
my attorney
following (specify):shown aboveat the address
4. I am willing for the following amount to be withheld from my earnings each pay period during the withholding period. I understand
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):
Nonea.
each pay period.b. Withhold $
5. I am paid
monthlyevery two weeks
daily
twice a month other (specify):weekly
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 that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)
CLAIM OF EXEMPTION
(Wage Garnishment)
Form Approved by the
Code of Civil Procedure, § 706.124
www.courtinfo.ca.gov
Judicial Council of California
WG-006 [Rev. January 1, 2009]
Page 1 of 1
WG-006
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
TELEPHONE NO.: FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
CITY AND ZIP CODE:
BRANCH NAME:
PLAINTIFF/PETITIONER:
DEFENDANT/RESPONDENT:
CLAIM OF EXEMPTION
CASE NUMBER:
STREET ADDRESS:
MAILING ADDRESS:
(Wage Garnishment)
FOR LEVYING OFFICER USE ONLY
LEVYING OFFICER FILE NUMBER:
(Levying Officer Name and Address)
1. My name is :
RETURN TO LEVYING OFFICER. DO NOT FILE WITH COURT
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