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):
each pay period.b. $
3. Please send all papers to
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):
each pay period.b. Withhold $
5. I am paid
monthlyevery two weeks
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.
(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)
CLAIM OF EXEMPTION
Form Approved by the
Code of Civil Procedure, § 706.124
Judicial Council of California
WG-006 [Rev. January 1, 2009]
Page 1 of 1
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:
CLAIM OF EXEMPTION
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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button after you have printed the form.
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