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

FOR  COURT  USE  ONLY

WG-020

TELEPHONE NO.:

FAX NO.:

ATTORNEY FOR STATE TAX AGENCY

NAME OF COURT:

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

APPLICATION OF (Name):

APPLICATION FOR EARNINGS WITHHOLDING ORDER FOR TAXES

TAXPAYER

RESPONDENT

/

NAME OF STATE TAX AGENCY:

CASE NUMBER:

TAX AGENCY NUMBER:

THE STATE OF CALIFORNIA APPLIES FOR AN EARNINGS WITHHOLDING ORDER FOR TAXES

1.  Employer (name and address):

2.  Employee-taxpayer (name and address):

3.  The amount of taxes, interest, and penalties owed is: $

4.  The amount to be withheld each pay period is: $

This amount exceeds the sum that can be withheld administratively.

A Temporary Earnings Withholding Order for Taxes (form WG-024) was served on the employer on (date):

5.

6.

The reason for this application is (specify):

IMPORTANT NOTICE TO TAXPAYER/EMPLOYEE

A. The state tax agency named above has asked the court to order money withheld from your earnings to pay a tax liability. The 
    amount due is shown in item 3.

B. The clerk of the court will send you a notice of the time and place of a court hearing. You have the right to appear at the hearing
    and ask for an exemption of up to seventy-five percent of your earnings.

C. A form called Claim of Exemption and Financial Declaration (Wage Garnishment—State Tax Liability) (form WG-026) is
enclosed. To claim an exemption, complete that form. File it with the clerk of the court and mail a copy to the tax agency 
as soon as possible.

D. Keep a copy of the Claim of Exemption and take it with you to the court hearing. 
E. If you wish to obtain the advice of an attorney, you should do so at once.

EMPLOYEE: KEEP THIS LEGAL PAPER

EMPLEADO: GUARDE ESTE PAPEL OFICIAL

Form Adopted for Mandatory Use 
Judicial Council of California 
WG-020 [Rev. January 1, 2007]

(Proof of service on reverse)

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

Code of Civil Procedure, §§ 706.075, 706.076
www.courtinfo.ca.gov

Page 1 of 2

APPLICATION OF (Name):

CASE NUMBER:

WG-020

TAXPAYER

RESPONDENT

/

PROOF OF SERVICE BY MAIL

1.   I am over the age of 18 and not a party to this cause. I am a resident of or employed in the county where the mailing occurred.

2.   My residence or business address is shown in the box labeled Attorney for State Tax Agency on the reverse.

3.   I served the foregoing Application for Earnings Withholding Order for Taxes by enclosing a copy in an envelope addressed to the
      taxpayer as shown in item 2 on the reverse AND

depositing the sealed envelope with the United States Postal Service with the postage fully prepaid. 

placing the envelope for collection and mailing on the date and at the place shown in item 4 below following our ordinary 
business practices. I am readily familiar with this business' practice for collecting and processing correspondence for 
mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course 
of business with the United States Postal Service in a sealed envelope with postage fully prepaid.

4.   a.   Date of deposit:

b.   Place of deposit (city and state):

5.   I served a Claim of Exemption and Financial Declaration (Wage Garnishment—State Tax Liability) (form WG-026) along with the 
      foregoing Application.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

a.

b.

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF DECLARANT)

WG-020 [Rev. January 1, 2007]

Page 2 of 2

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