ATTORNEY (Name, State Bar number, and address):

WG-024

TELEPHONE NO.:

FAX NO.:

ATTORNEY FOR STATE TAX AGENCY

APPLICATION OF (Name):

TEMPORARY EARNINGS WITHHOLDING ORDER FOR TAXES

TAXPAYER/RESPONDENT

NAME OF STATE TAX AGENCY:

TAX AGENCY NUMBER:

TO EMPLOYER
1.   Employer (name and address):

2.   Employee (name and address):

3.   You are directed to withhold from the employee’s earnings and retain in your possession or control all disposable earnings now
      due the employee or that become due within 15 days after this order is served on you, as follows: 

4.   This order expires 15 days after service on the employer, or upon order of the court, whichever occurs first, unless extended
      by court order.

5.   DELIVER ONE COPY OF THIS ORDER TO THE EMPLOYEE IMMEDIATELY.

a.   Employee’s tax liability: $

b.  Total to be withheld: $

Date:

(TYPE OR PRINT NAME AND TITLE)

(SIGNATURE)

IMPORTANT NOTICE TO TAXPAYER/EMPLOYEE

A.  Your employer is required to withhold from your earnings all sums necessary to meet the tax liability shown in item 3a and pay   
      them to the tax agency shown above.

B.  This Temporary Earnings Withholding Order will expire 15 days after service upon your employer, unless it is extended by the
      court.
C.  The State will apply to the court for an Earnings Withholding Order for Taxes directing your employer to continue to withhold
      money from your earnings.  You will receive additional information on how to file a Claim of Exemption and when and where to
      appear for a court hearing.

This form is served in duplicate on the employer.

EMPLOYER:     DELIVER ONE COPY TO THE EMPLOYEE, AND COMPLETE THE EMPLOYER’S RETURN AND MAIL IT TO
                          THE STATE TAX AGENCY NOTED ABOVE.

Form Adopted for Mandatory Use 
    Judicial Council of California 
   WG-024 [Rev. January 1, 2007]

TEMPORARY EARNINGS WITHHOLDING
ORDER FOR TAXES
(Wage Garnishment-State Tax Liability)

Page 1 of 1

Code of Civil Procedure, § 706.076
www.courtinfo.ca.gov