COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. Calendar No. CASE NUMBER: CONFIDENTIAL APPLICATION OF (Name): : : : WG-021 Plaintiff(s) -againstTAXPAYER JUDICIAL SUBPOENA / RESPONDENT CONFIDENTIAL STATEMENT OF TAXPAYER'S : SOCIAL SECURITY NUMBER Supplement to Application for Earnings Withholding Order for Taxes (Form WG-020) (Do not attach to Application) Defendant(s) : : ...................................................... This separate Confidential Statement of Taxpayer's Social Security Number contains the social security number of the taxpayer-respondent in the case referenced above. This supplement should be kept separate from the Application for Earnings Withholding Order for Taxes filed in this case, and THE PEOPLE OF THE STATE should not be a public record. OF NEW YORK INFORMATION ON TAXPAYER-RESPONDENT: 1. Name: 2. Social Security Number: 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 TO COURT CLERK County of in room , on the THIS STATEMENT IS CONFIDENTIAL. DO NOT in the day of , 20 , at o'clock FILE noon, and at any recessed THIS CONFIDENTIAL STATEMENT IN A PUBLIC COURT FILE. or adjourned date, to testify and give evidence as a witness in this action on the part of the GREETINGS: TO Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a 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) Attorney(s) for Office and P.O. Address Form Adopted for Mandatory Use Judicial Council of California WG-021 [Rev. January 1, 2007] CONFIDENTIAL SUPPLEMENT TO APPLICATION FOR EARNINGS WITHHOLDING ORDER FOR TAXES (Wage Garnishment-State Tax Liability) Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com