RETURN TO LEVYING OFFICER. DO NOT FILE WITH COURT ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR LEVYING OFFICER USE ONLY (Levying Officer Name and Address) WG-006 TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: LEVYING OFFICER FILE NUMBER: PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CLAIM OF EXEMPTION (Wage Garnishment) FOR COURT USE ONLY 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. 1. My name is : 2. I need the following earnings to support myself or my family (check a or b): a. All earnings. b. $ each pay period. CASE NUMBER: 3. Please send all papers to me. my attorney at the address shown above following (specify): 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): a. b. 5. I am paid daily weekly None Withhold $ every two weeks twice a month each pay period. monthly other (specify): 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) Form Approved by the Judicial Council of California WG-006 [Rev. January 1, 2009] (SIGNATURE OF DECLARANT) Page 1 of 1 Code of Civil Procedure, § 706.124 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com CLAIM OF EXEMPTION (Wage Garnishment)