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Here is the text we could read:

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

LEVYING OFFICER (Name and Address):

WG-001

FAX NO.:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:

TELEPHONE NO.:

E-MAIL ADDRESS:

ATTORNEY FOR (Name):

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PLAINTIFF/PETITIONER:

DEFENDANT/RESPONDENT:

APPLICATION FOR EARNINGS WITHHOLDING ORDER
(Wage Garnishment)

TO THE SHERIFF OR ANY MARSHAL OR CONSTABLE OF THE COUNTY OF:
OR ANY REGISTERED PROCESS SERVER
1. The judgment creditor (name):

issuance of an Earnings Withholding Order directing the employer to withhold the earnings of the judgment debtor (employee).

Name and address of employer

Name and address of employee

requests

COURT CASE NUMBER:

LEVYING OFFICER FILE NUMBER:

2. The amounts withheld are to be paid to

The attorney (or party without an attorney)
named at the top of this page.

Social Security no.

on form WG-035

unknown

(name, address, and telephone):
Other

3. a. Judgment was entered on (date):

4. Check any that apply:

b. Collect the amount directed by the Writ of Execution unless a lesser amount is specified here: $:

The Writ of Execution was issued to collect delinquent amounts payable for the support of a child, former spouse, or
spouse of the employee.
The Writ of Execution was issued to collect a judgment based entirely on a claim for elder or dependent adult financial
abuse.
The Writ of Execution was issued to collect a judgment based in part on a claim for elder or dependent adult financial
abuse.
The amount that arises from the claim for elder or dependent adult financial abuse is (state amount): $:

Special instructions (specify):

6. Check a or b:

I have not previously obtained an order directing this employer to withhold the earnings of this employee.
OR
I have previously obtained such an order, but that order (check one):

was terminated by a court order, but I am entitled to apply for another Earnings Withholding Order under the
provisions of Code of Civil Procedure section 706.105(h).
was ineffective.

(TYPE OR PRINT NAME)

(SIGNATURE OF ATTORNEY OR PARTY WITHOUT ATTORNEY)

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)

Form Adopted for Mandatory Use
Judicial Council of California
WG-001 [Rev. January 1, 2012]

APPLICATION FOR EARNINGS WITHHOLDING ORDER
(Wage Garnishment)

(SIGNATURE OF DECLARANT)

Code of Civil Procedure, § 706.121

Page 1 of 1

Application for Earnings Withholding Order

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): 1
Fields(s): 39
Average fields per page: 39
Reading Level: Grade 8
LIST Grouping(s): Unknown

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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.

Here are the fields we could identify.

w_g_page_std_p_info_number was WG-001[0].Page1[0].StdP1Header_sf[0].LevOfcrInfo_sf[0].LevNumber_ft1[0] (0.60 conf)
w_g_page_std_p_case_number was WG-001[0].Page1[0].StdP1Header_sf[0].CaseNumber[0].CaseNumber_ft[0] (0.38 conf)
w_g_page_std_p_sf_number was WG-001[0].Page1[0].StdP1Header_sf[0].LevNumber_sf[0].LevNumber_ft[0] (0.45 conf)
w_page_std_p_party_info_add was WG-001[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].Add1[0] (0.39 conf)
w_page_std_p_party_info was WG-001[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].Phone[0] (0.39 conf)
w_page_std_p_header_party_info__1 was WG-001[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].Fax[0] (0.39 conf)
w_page_std_p_info_email was WG-001[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].Email[0] (0.39 conf)
w_page_std_p_header_party_info__2 was WG-001[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].AttyFor[0] (0.38 conf)
w_page_std_p_info_county was WG-001[0].Page1[0].StdP1Header_sf[0].CourtInfo[0].CrtCounty_ft[0] (0.37 conf)
w_page_std_p_info_street was WG-001[0].Page1[0].StdP1Header_sf[0].CourtInfo[0].Street_ft[0] (0.40 conf)
w_page_std_p_info_branch was WG-001[0].Page1[0].StdP1Header_sf[0].CourtInfo[0].Branch_ft[0] (0.39 conf)
w_page_std_p_header_info_city was WG-001[0].Page1[0].StdP1Header_sf[0].CourtInfo[0].CityZip_ft[0] (0.38 conf)
w_page_std_p_header_info was WG-001[0].Page1[0].StdP1Header_sf[0].CourtInfo[0].MailingAdd_ft[0] (0.38 conf)
w_page_std_p_title_party_name__1 was WG-001[0].Page1[0].StdP1Header_sf[0].TitlePartyName[0].Party1_ft[0] (0.41 conf)
w_page_std_p_title_party_name__2 was WG-001[0].Page1[0].StdP1Header_sf[0].TitlePartyName[0].Party2_ft[0] (0.41 conf)
w_g_page_note_field was WG-001[0].Page1[0].Note[0].Field1[0] (0.34 conf)
w_page_list_judgment_name was WG-001[0].Page1[0].List1[0]._1\.judgment\.creditor\.name[0] (0.34 conf)
w_g_page_list_li_field was WG-001[0].Page1[0].List1[0].Li1[0].Field2[0] (0.33 conf)
w_g_page_list_li_area_field was WG-001[0].Page1[0].List1[0].Li2[0].#area[0].Field4[0] (0.33 conf)
w_g_page_list_li_ssn__1 was WG-001[0].Page1[0].List1[0].Li2[0].ssn[0] (0.34 conf)
w_g_page_list_li_ssn__2 was WG-001[0].Page1[0].List1[0].Li2[0].ssn[1] (0.34 conf)
w_g_page_list_lia_ch was WG-001[0].Page1[0].List2[0].Lia[0].Ch1[0] (0.33 conf)
w_g_page_list_lib_ch was WG-001[0].Page1[0].List2[0].Lib[0].Ch2[0] (0.33 conf)
w_g_page_list_lib_field__1 was WG-001[0].Page1[0].List2[0].Lib[0].Field6[0] (0.33 conf)
w_g_page_list_lia_date was WG-001[0].Page1[0].List3[0].Lia[0].Date2[0] (0.33 conf)
w_g_page_list_lib_field__2 was WG-001[0].Page1[0].List3[0].Lib[0].Field8[0] (0.33 conf)
w_g_page_list_lia_check_box was WG-001[0].Page1[0].List4[0].Lia[0].CheckBox20[0] (0.40 conf)
w_g_page_list_lib_check_box was WG-001[0].Page1[0].List4[0].Lib[0].CheckBox21[0] (0.40 conf)
w_g_page_list_lic_check_box was WG-001[0].Page1[0].List4[0].Lic[0].CheckBox22[0] (0.40 conf)
w_g_page_list_lic_field was WG-001[0].Page1[0].List4[0].Lic[0].Field10[0] (0.33 conf)
w_g_page_list_item_check_box was WG-001[0].Page1[0].List5[0].item5[0].CheckBox25[0] (0.39 conf)
w_g_page_list_item_field was WG-001[0].Page1[0].List5[0].item5[0].Field12[0] (0.34 conf)
w_g_page_list_lia_cb_choice was WG-001[0].Page1[0].List6[0].Lia[0].CBChoice1_cb[0] (0.34 conf)
w_g_page_list_lib_cb_choice was WG-001[0].Page1[0].List6[0].Lib[0].CBChoice1_cb[0] (0.34 conf)
w_g_list_lib_sub_check_box__1 was WG-001[0].Page1[0].List6[0].Lib[0].SubLib[0].Lii1[0].CheckBox30[0] (0.39 conf)
w_g_list_lib_sub_check_box__2 was WG-001[0].Page1[0].List6[0].Lib[0].SubLib[0].Lii2[0].CheckBox30[0] (0.39 conf)
w_g_page_sign_field was WG-001[0].Page1[0].Sign1[0].Field22[0] (0.34 conf)
w_g_page_decleration_date was WG-001[0].Page1[0].Decleration[0].Date4[0] (0.34 conf)
w_g_page_decleration_print_name was WG-001[0].Page1[0].Decleration[0].PrintName1[0] (0.35 conf)

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

Application for Earnings Withholding Order

About This Form:

Identified Data Fields:

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