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ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

FOR COURT USE ONLY

WG-026

TELEPHONE NO:

FAX NO.:

ATTORNEY FOR STATE TAXPAYER/RESPONDENT:

NAME OF COURT:

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

APPLICATION OF (Name):

CLAIM OF EXEMPTION AND FINANCIAL DECLARATION

NAME OF STATE TAX AGENCY:

CASE NUMBER:

TAX AGENCY NUMBER:

TAXPAYER/RESPONDENT

(Copy the information required above from the Application for Earnings Withholding Order for Taxes (form WG-020). The top 
left space is for your or your attorney's name and address.)

1.   I need the following earnings to support myself or my family (check and complete item a or b):

a.

All earnings.

b.

each pay period.

$

me

2.   Please send all papers to

my attorney

at the address

shown above

following (specify):

3.   In addition to the 25 percent minimum withholding, I am willing for the following amount to be withheld from my earnings during the   
      withholding period:

a.

None

b.

Withhold:  $

each pay period.

4.   a.   I am paid

daily

weekly

every two weeks 

twice a month

monthly.

b.   My gross pay is: $

per pay period.

c.   My take-home pay is: $

per pay period.

d.   My payroll deductions are (item and amount):

5.   The following persons depend, in whole or in part, on me for support:

Name

Age

Relationship to me

Monthly income and its source

Myself

a.

b.

c.

d.

e.

6.

The earnings of others listed in item 5 are now subject to wage assignments and Earnings Withholding Orders as follows
(specify):

Form Adopted for Mandatory  Use 
Judicial Council of California 
WG-026 [Rev. January 1, 2007]

CLAIM OF EXEMPTION AND FINANCIAL DECLARATION 
(Wage Garnishment-State Tax Liability)

Code of Civil Procedure, §§ 706.051, 706.076
www.courtinfo.ca.gov

Page 1 of 2

APPLICATION OF (Name):

CASE NUMBER:

WG-026

7.   My monthly expenses are as follows:
      a. Rent or house payment and

maintenance   . . . . . . . . . . . . . . . . . .  $
b. Food and household supplies . . . . . .  $
c. Utilities and telephone   . . . . . . . . . . .  
$
d. Clothing   . . . . . . . . . . . . . . . . . . . . . .  $
e. Laundry and cleaning   . . . . . . . . . . .  $
f.  Medical and dental payments   . . . . . . 
$
g. Insurance (life, health,

accident, etc.)   . . . . . . . . . . . . . . . . . . $
h. School, child care   . . . . . . . . . . . . . . .$
i.  Child, spousal support

(prior marriage)   . . . . . . . . . . . . . . . .

$

TAXPAYER/RESPONDENT

j.  Entertainment and incidentals   . . . .
k. Transportation and auto expenses

$

(insurance, gas, repair)   . . . . . . . . . .  $

l.  Installment payments (insert

total and list below in item 8)   . . . . . .  $
$

m. Other (specify):   . . . . . . . . . . . . . . . .

TOTAL MONTHLY EXPENSES
(add a through m)   . . . . . . . . . . . . . . . .

$

8.   List payments on installment and other debts.

Continued on Attachment 8.

Creditor's name

For

Monthly payment

Balance

10.

An Order Assigning Salary and Wages (for support) is now in effect as to my earnings. The amount payable under that order
is: $

monthly.

11.  Other facts that support this Claim of Exemption are (describe unusual medical needs, school tuition, expenses for recent family
Continued on Attachment 11.

emergencies, or other unusual expenses to help the judge understand your budget):

d.  Real estate equity (addresses):  . . 

$

e.  Other personal property (jewelry,

furniture, furs, stocks and bonds, etc. 
List separately):

Total for item e:   . . . $

$

$ $ $ $

$ $ $

9. What do you own? (State value.)

a. Cash   . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Checking, savings and credit union
    accounts, etc. (list institutions):

c.   Cars, other vehicles, and boat equity 
      (list make, year of each):

(1)
(2)

(3)
(4)

(1)
(2)

(3)

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

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF TAXPAYER)

File this form with the clerk of the court and mail a copy to the tax agency as soon as possible. Keep a copy and take it 
with you to the court hearing. If you wish to obtain the advice of an attorney, you should do so at once.

WG-026 [Rev. January 1, 2007]

CLAIM OF EXEMPTION AND FINANCIAL DECLARATION 
(Wage Garnishment-State Tax Liability)

Page 2 of 2

Claim of Exemption and Financial Declaration (State Tax Liability)

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 2
Fields(s): 114
Average fields per page: 57
Reading Level: Grade 8
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Claim of Exemption and Financial Declaration (State Tax Liability)

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02