1 [Name; State Bar ID No.] [Address] 2 3 4 [Telephone] Attorney for Debtor/Debtor In Propria Persona 5 UNITED STATES BANKRUPTCY COURT 6 EASTERN DISTRICT OF CALIFORNIA 7 8 In re 9 10 Debtor(s). 11 ) ) ) ) ) ) Case No. WAGE ORDER 12 GOOD CAUSE APPEARING, IT IS HEREBY ORDERED THAT [insert name and address of employer] 13 , 14 the employer of the above-named debtor, be and is hereby directed until further court order to deduct from the 15 debtor’s wages, and forward to the Chapter 13 Trustee, [insert Trustee’s name] , 16 at [insert Trustee’s mailing address] , 17 the sum of $ 18 income tax withholding, federal social security, state disability, insurance premiums, union dues, employee 19 welfare fund agreements, mandatory retirement contributions, and employer sustenance agreements are not 20 affected by this order and may be continued. 21 each month. Payroll deductions made in accordance with the applicable law for current A copy of this order shall be served by mail on the present and subsequent employers of the debtor. 22 Monies transmitted to the Trustee shall be identified by the debtor’s name and case number as they appear 23 above. 24 Dated: 25 For the Court Wayne Blackwelder Clerk, U.S. Bankruptcy Court 26 27 28 By: EDC 3-083-01 (Rev. 09/01/10) Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com