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

FOR COURT USE ONLY

WG-022

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):

EARNINGS WITHHOLDING ORDER FOR TAXES

NAME OF STATE TAX AGENCY:

CASE NUMBER:

TAX AGENCY NUMBER:

TAXPAYER  /  RESPONDENT

1.   The State's Application for Earnings Withholding Order for Taxes came on for hearing on
Div.:
in

(date):

Dept.:

Room:

before (name of judicial officer):

2.

Attorney for state tax agency present in court (name):

Taxpayer present in court.

Attorney for taxpayer present in court (name):

a.

b.

c.

3.   The court has considered

the taxpayer's Claim of Exemption and Financial Declaration

the evidence presented

the parties' stipulation.

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):

c.

$

has been withheld from the employee's earnings under a Temporary Earnings Withholding Order for Taxes.

5.   THE COURT ORDERS the employer to

a.  withhold and pay to the state tax agency: $

from the employee's disposable earnings each month. 

b.  pay to the employee any disposable earnings above that amount, not to exceed:   $     

per month.

c.  WITHHOLD AND PAY TO THE STATE TAX AGENCY ANY DISPOSABLE EARNINGS ABOVE THOSE SET FORTH IN 
     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.

 f.  send all sums withheld to the state tax agency within 10 days after the last paycheck of each month.

g.

other (specify):

Date:

Form Adopted for Mandatory Use 
Judicial Council of California 
WG-022 [Rev. January 1, 2007]

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

Page 1 of 2

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

(Instructions to employer on reverse)

JUDICIAL OFFICER

APPLICATION OF (Name):

CASE NUMBER:

WG-022

TAXPAYER

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
:
Second: 
Third:
Fourth:

Order Assigning Salary or Wages
Earnings Withholding Order for Support
Earnings Withholding Order for Taxes 
Earnings Withholding Order

WG-022 [Rev January 1, 2007]

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

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