COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : ATTORNEY (Name, State Bar number, and address): WG-020 FOR COURT USE ONLY : -against- Calendar No. : Plaintiff(s) TELEPHONE NO.: Index No. JUDICIAL SUBPOENA : FAX NO.: ATTORNEY FOR STATE TAX AGENCY : NAME OF COURT: STREET ADDRESS: : MAILING ADDRESS: CITY AND ZIP CODE: Defendant(s) : BRANCH NAME: ...................................................... APPLICATION OF (Name): TAXPAYER / RESPONDENT THE PEOPLE OF THE STATE OF NEW YORK ORDER FOR TAXES APPLICATION FOR EARNINGS WITHHOLDING CASE NUMBER: TAX AGENCY NUMBER: NAME OF STATE TAX AGENCY: TO THE STATE OF CALIFORNIA APPLIES FOR AN EARNINGS WITHHOLDING ORDER FOR TAXES 1. Employer (name and address): GREETINGS: 2. Employee-taxpayer (name and address): WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the 3. The amount of taxes, interest, and penalties owed is: $ 4. The amount to be withheld each pay period is: $ 5. 6. This amount exceeds the sum that can be withheld administratively. A Temporaryfailure to Withholding Order for Taxes (form WG-024) was served on the employer on will make Your Earnings comply with this subpoena is punishable as a contempt of court and (date): you liable to the The reason for thisbehalf this is (specify): was issued for a maximum penalty of $50 and all damages sustained as a party on whose application subpoena result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) IMPORTANT NOTICE TO TAXPAYER/EMPLOYEE A. The state tax agency named above has asked the court to order money withheld from your earnings to pay a tax liability. The amount due is shown in item 3. Attorney(s) for B. The clerk of the court will send you a notice of the time and place of a court hearing. You have the right to appear at the hearing and ask for an exemption of up to seventy-five percent of your earnings. C. A form called Claim of Exemption and Financial Declaration (Wage Garnishment—State Tax Liability) (form WG-026) is enclosed. To claim an exemption, complete that form. File it with the clerk of the court and mail a copy to the tax agency as soon as possible. Office D. Keep a copy of the Claim of Exemption and take it with you to the court hearing. and E. If you wish to obtain the advice of an attorney, you should do so at once. P.O. Address EMPLEADO: Telephone No.: GUARDE ESTE PAPEL OFICIAL Facsimile No.: (Proof of service on reverse) Page 1 of 2 E-Mail Address: Code of Civil Procedure, §§ 706.075, 706.076 APPLICATION FOR EARNINGS Tel. No.: www.courtinfo.ca.gov Mobile WITHHOLDING ORDER FOR TAXES EMPLOYEE: KEEP THIS LEGAL PAPER Form Adopted for Mandatory Use Judicial Council of California WG-020 [Rev. January 1, 2007] (Wage Garnishment-State Tax Liability) American LegalNet, Inc. www.FormsWorkflow.com WG-020 CASE NUMBER: APPLICATION OF (Name): TAXPAYER / RESPONDENT PROOF OF SERVICE BY MAIL 1. I am over the age of 18 and not a party to this cause. I am a resident of or employed in the county where the mailing occurred. 2. My residence or business address is shown in the box labeled Attorney for State Tax Agency on the reverse. 3. I served the foregoing Application for Earnings Withholding Order for Taxes by enclosing a copy in an envelope addressed to the taxpayer as shown in item 2 on the reverse AND a. depositing the sealed envelope with the United States Postal Service with the postage fully prepaid. b. placing the envelope for collection and mailing on the date and at the place shown in item 4 below following our ordinary business practices. I am readily familiar with this business' practice for collecting and processing correspondence for mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of business with the United States Postal Service in a sealed envelope with postage fully prepaid. 4. a. Date of deposit: b. Place of deposit (city and state): 5. I served a Claim of Exemption and Financial Declaration (Wage Garnishment—State Tax Liability) (form WG-026) along with the foregoing Application. 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) WG-020 [Rev. January 1, 2007] (SIGNATURE OF DECLARANT) APPLICATION FOR EARNINGS WITHHOLDING ORDER FOR TAXES (Wage Garnishment-State Tax Liability) Page 2 of 2