APPLICATION OF (Name):

CASE NUMBER:

CONFIDENTIAL

WG-021

TAXPAYER

/

RESPONDENT

CONFIDENTIAL STATEMENT OF TAXPAYER'S 
SOCIAL SECURITY NUMBER

Supplement to Application for Earnings Withholding Order for Taxes (Form WG-020) 
(Do not attach to Application)

This separate Confidential Statement of Taxpayer's Social Security Number contains the social 
security number of the taxpayer-respondent in the case referenced above. This supplement should 
be kept separate from the Application for Earnings Withholding Order for Taxes filed in this case, and 
should not be a public record.

INFORMATION ON TAXPAYER-RESPONDENT:

1.   Name:

2.   Social Security Number:

TO COURT CLERK
THIS STATEMENT IS CONFIDENTIAL. DO NOT FILE
 THIS CONFIDENTIAL STATEMENT IN A PUBLIC COURT FILE.

Form Adopted for Mandatory Use 
Judicial Council of California 
WG-021 [Rev. January 1, 2007]

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

Page 1 of 1



Confidential Supplement to Application for Earnings Withholding Order for Taxes (State Tax Liability)

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