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TELEPHONE NO.: LEVYING OFFICER (Name and Address): ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): ATTORNEY FOR (Name): NAME OF COURT, JUDICIAL DISTRICT, OR BRANCH COURT, IF ANY: PLAINTIFF: DEFENDANT: LEVYING OFFICER FILE NO.: COURT CASE NO.: APPLICATION FOR EARNINGS WITHHOLDING ORDER (Wage Garnishment) TO THE SHERIFF OR ANY MARSHAL OR CONSTABLE OF THE COUNTY OF OR ANY REGISTERED PROCESS SERVER 1. The judgment creditor (name): requests issuance of an Earnings Withholding Order directing the employer to withhold the earnings of the judgment debtor (employee). Name and address of employee Social Security Number (if known): 2. The amounts withheld are to be paid to a. The attorney (or party without an attorney) named at the top of this page. b. Other (name, address, and telephone): 3. a. Judgment was entered on (date): b. Collect the amount directed by the Writ of Execution unless a lesser amount is specified here: $ The Writ of Execution was issued to collect delinquent amounts payable for the support of a child, former spouse, or spouse of the employee. 4. 5. Special instructions (specify): (Check a or b) a. I have not previously obtained an order directing this employer to withhold the earnings of this employee. OR b. I have previously obtained such an order, but that order (check one): was terminated by a court order, but I am entitled to apply for another Earnings Withholding Order under the provisions of Code of Civil Procedure section 706.105(h). (TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY OR PARTY WITHOUT ATTORNEY) Date: (SIGNATURE OF DECLARANT) (TYPE OR PRINT NAME) Code Civ. Procedure, § 706.121 www.courtinfo.ca.gov APPLICATION FOR EARNINGS WITHHOLDING ORDER (Wage Garnishment) Name and address of employer 6. was ineffective. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Form Adopted by the Judicial Council of California WG-001 [Rev. January 1, 2007] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WG-001 Page 1 of 1 To keep other people from seeing what you entered on your form, please press the Clear This Form button at the end of the form when finished. For your protection and privacy, please press the Clear This Form button after you have printed the form. Save This Form Print This Form Clear This Form