COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : ATTORNEY (Name, State Bar number, and address): Index No. FOR COURT USE ONLY WG-022 : Plaintiff(s) : : : : Calendar No. JUDICIAL SUBPOENA TELEPHONE NO.: ATTORNEY FOR STATE TAX AGENCY: NAME OF COURT: STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE -against- NO.: FAX Defendant(s) BRANCH NAME: : . . . . . . . . OF. (Name): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ...... APPLICATION TAXPAYER / RESPONDENT EARNINGS WITHHOLDING ORDER FOR THE PEOPLE OF THE STATE OF NEW YORK TAXES NAME OF STATE TAX AGENCY: CASE NUMBER: TAX AGENCY NUMBER: TO 1. The State's Application for Earnings Withholding Order for Taxes came on for hearing on (date): in Dept.: Div.: before (name of judicial officer): Room: GREETINGS: 2. a. b. Attorney for state tax agency present in court (name): WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Taxpayer present in court. , the Honorable at the Court Attorney for taxpayer present in court (name): c. located at County of the Financial Declaration 3. The court has considered in room , on the day oftaxpayer's Claim of Exemption and o'clock in the , 20 , at noon, and at any recessed the evidence presented the parties' stipulation. or adjourned date, to testify and give evidence as a witness in this action on the part of the 4. THE COURT FINDS a. The taxpayer (employee) is entitled to a monthly exemption of: $ b. The taxpayer is employed by (name and address of employer): 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,has been withheld from the employee's earnings under a Temporary EarningsJustices of the for Taxes. Honorable , one of the Withholding Order Court in , 20 5. THE COURT ORDERS the County, to day of employer a. withhold and pay to the state tax agency: $ from the employee's disposable earnings each month. per month. b. pay to the employee any disposable earnings above that amount, not to exceed: $ (Attorney must sign above and type name below) IN c. WITHHOLD AND PAY TO THE STATE TAX AGENCY ANY DISPOSABLE EARNINGS ABOVE THOSE SET FORTH ITEMS 4a AND 4b. d. begin withholding with the first pay period that ends on or after the 10th day after this order is served. e. continue withholding until the tax liability has been satisfied unless an order with higher priority is received. Attorney(s) for f. send all sums withheld to the state tax agency within 10 days after the last paycheck of each month. g. other (specify): c. Office and P.O. Address Date: Form Adopted for Mandatory Use Judicial Council of California WG-022 [Rev. January 1, 2007] Telephone No.: Facsimile No.: (Instructions to employer on reverse) Address: E-Mail Mobile TAXES EARNINGS WITHHOLDING ORDER FOR Tel. No.: (Wage Garnishment-State Tax Liability) JUDICIAL OFFICER Page 1 of 2 Code of Civil Procedure, § 706.076 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com WG-022 APPLICATION OF (Name): TAXPAYER CASE NUMBER: / RESPONDENT INSTRUCTIONS TO EMPLOYER A. When remitting withheld sums to the state tax agency, include the employee's name and social security number, and the tax agency number. B. PRIORITY OF EARNINGS WITHHOLDING ORDERS First Order Assigning Salary or Wages : Second: Earnings Withholding Order for Support Third: Earnings Withholding Order for Taxes Fourth: Earnings Withholding Order WG-022 [Rev January 1, 2007] EARNINGS WITHHOLDING ORDER FOR TAXES (Wage Garnishment-State Tax Liability) Page 2 of 2