COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :
ATTORNEY (Name, State Bar number, and address):
Index No. Calendar No.
: Plaintiff(s) : : : :
TELEPHONE NO.: ATTORNEY FOR STATE TAX AGENCY
APPLICATION OF (Name):
Defendant(s) : ......................................................
NAME OF STATE TAX AGENCY:
TEMPORARY EARNINGS WITHHOLDING ORDER FOR TAXES
TAX AGENCY NUMBER:
THE PEOPLE OF THE STATE OF NEW YORK
TO EMPLOYER TO 1. Employer (name and address): 2. Employee (name and address):
GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at retain Court 3. You are directed to withhold from the employee's earnings and the in your possession or control all disposable earnings now located at County of due the employee or that become due within 15 days after this order is served on you, as follows: , on the day of , 20 , at o'clock in the noon, and at any recessed a. in room Employee's tax liability: $ or adjourned date, to testify and give evidence as a witness in this action on the part of the
b. Total to be withheld: $ 4. This order expires 15 days after service on the employer, or upon order of the court, whichever occurs first, unless extended by court order.
Your failure to comply with this subpoena is punishable as 5. DELIVER ONE COPY OF THIS ORDER TO THE EMPLOYEE IMMEDIATELY.
a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. , one of the Justices of the day of , 20
Witness, Honorable Court in County,
(TYPE OR PRINT NAME AND TITLE)
IMPORTANT NOTICE TO TAXPAYER/EMPLOYEE
(Attorney must sign above and type name below)
A. Your employer is required to withhold from your earnings all sums necessary to meet the tax liability shown in item 3a and pay them to the tax agency shown above.
Attorney(s) for B. This Temporary Earnings Withholding Order will expire 15 days after service upon your employer, unless it is extended by the court. C. The State will apply to the court for an Earnings Withholding Order for Taxes directing your employer to continue to withhold money from your earnings. You will receive additional information on how to file a Claim of Exemption and when and where to appear for a court hearing. Office and P.O. Address
This form is served in duplicate on the employer. EMPLOYER: DELIVER ONE COPY TO THE EMPLOYEE, AND COMPLETE THE EMPLOYER'S RETURN AND MAIL IT TO THE STATE TAX AGENCY NOTED ABOVE. Telephone No.:
Form Adopted for Mandatory Use Judicial Council of California WG-024 [Rev. January 1, 2007]
Facsimile No.: E-Mail Address: TEMPORARY EARNINGS WITHHOLDING Mobile Tel. No.: ORDER FOR TAXES
(Wage Garnishment-State Tax Liability)
Page 1 of 1 Code of Civil Procedure, § 706.076 www.courtinfo.ca.gov
American LegalNet, Inc. www.FormsWorkflow.com