WG-004 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): LEVYING OFFICER (Name and Address): TELEPHONE NO.: E-MAIL ADDRESS: ATTORNEY FOR (Name): FAX NO.: SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: COURT CASE NUMBER: EARNINGS WITHHOLDING ORDER FOR SUPPORT (Wage Garnishment) EMPLOYEE: KEEP YOUR COPY OF THIS LEGAL PAPER. EMPLOYER: Enter the following date to assist your record keeping. LEVYING OFFICER FILE NUMBER: EMPLEADO: GUARDE ESTE PAPEL OFICIAL. Date this order was received by employer (specify the date of personal delivery by levying officer or registered process server or the date mail receipt was signed): TO THE EMPLOYER REGARDING YOUR EMPLOYEE: Name and address of employee Name and address of employee Social Security No. on form WG-035 unknown 1. A judgment creditor has obtained this order to collect a court judgment against your employee. You are directed to withhold part of the earnings of the employee (see instructions on reverse of this form). Pay the withheld sums to the levying officer (name and address above). If the employee works for you now, you must give the employee a copy of this order and the Employee Instructions within 10 days after receiving this order. Complete both copies of the form Employer's Return and mail them to the levying officer within 15 days after receiving this order, whether or not the employee works for you. 2. The total amount due is: $ Count 10 calendar days from the date when you received this order. If your employee's pay period ends before the tenth day, do not withhold earnings payable for that pay period. Do withhold from earnings that are payable for any pay period ending on or after that tenth day. Continue withholding until (1) the total amount due has been withheld; or (2) you receive a court order or an order from the levying officer telling you to stop the withholding earlier. 3. The judgment was entered in the court shown above. The judgment creditor is (name): 4. The EMPLOYER'S INSTRUCTIONS on the reverse tell you how much of the employee's earnings to withhold each payday. Follow those instructions unless you receive a court order or order from the levying officer giving you other instructions. Date: (TYPE OR PRINT NAME) LEVYING OFFICER (SIGNATURE) REGISTERED PROCESS SERVER The EMPLOYER'S INSTRUCTIONS on the reverse contain special rules that apply to Earnings Withholding Order for Support. Read the instructions carefully. (Employer's Instructions on reverse) Form Adopted for Mandatory Use Judicial Council of California WG-004 [Rev. January 1, 2012] Page 1 of 2 EARNINGS WITHHOLDING ORDER FOR SUPPORT (Wage Garnishment) Code of Civil Procedure, §§ 706 030, 706.108, 706.052 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com EMPLOYER'S INSTRUCTIONS (EARNINGS WITHHOLDING ORDERS FOR SUPPORT) The instructions apply only to Earnings Withholding Orders for Support. Applicable instructions appear on the reverse of the other types of Earnings Withholding Orders. The instructions in paragraph 1 on the reverse of this form describe your early duties to provide information to your employee and the levying officer. Your other duties are TO WITHHOLD THE CORRECT AMOUNT OF EARNINGS (if any) and PAY IT TO THE LEVYING OFFICER during the withholding period. The usual withholding period begins ten (10) calendar days after you receive the Earnings Withholding Order. In the case of an Earnings Withholding Order for Support (this Order) the withholding period continues until one of two things happens: (1) the total amount specified in the Order, plus any amounts listed in a notice from the levying officer, has been withheld,or (2) you receive a court order or notice signed by the levying officer specifying a termination date. You are entitled to rely on and should obey all written notices signed by the levying officer. The form Employer's Return describes several situations that could affect the withholding period for this order. If you receive more than one Earnings Withholding Order during a withholding period, review that form (Employer's Return) for instructions. Your duty to withhold does not end merely because the employee no longer works for you. Withholding for an Earnings Withholding Order for Support does not automatically terminate until one year after the employment of the employee by the employer ends. WHAT TO DO WITH THE MONEY The amounts withheld during the withholding period must be paid to the levying officer by the 15th of the next month after each payday. If you wish to pay more frequently than monthly, each payment must be made within ten (10) days after the close of the pay period. Be sure to mark each check with the case number, the levying officer's file number, if different, and the employee's name so the money will be applied to the correct account WHAT IF YOU STILL HAVE QUESTIONS? The garnishment law is contained in the Code of Civil Procedure beginning with section 706.010. Sections 706.022, 706.025, and 706.104 explain the employer's duties. WG-004 The Federal Wage Garnishment Law and federal rules provide the basic protections on which the California law is based. Inquiries about the federal law will be answered by mail, telephone or personal interview at any office of the Wage and Hour Division of the U.S. Department of Labor. Offices are listed in the telephone directory under the U.S. Department of Labor in the U.S. Government listing. COMPUTATION INSTRUCTIONS State and federal law limits the amount of earnings that can be withheld. The limitations are based on the employee's disposable earnings, which are different from gross pay or take-home pay. To determine the CORRECT AMOUNT OF EARNINGS TO BE WITHHELD (if any), compute the employee's disposable earnings. (A) Earnings include any money, (whether called wages, salary, commissions, bonuses or anything else) that is paid by an employer to an employee for personal services. Vacation or sick pay is subject to withholding as it is received by the employee. Tips are generally not included as earning since they are not paid by the employer. (B) Disposable earnings are the earnings left after subtracting the part of the earnings a state or federal law requires an employer to withhold. Generally these required deductions are (1) federal income tax, (2) federal social security, (3) state income tax, (4) state disability insurance, a