FAILURE TO COMPLETE AND RETURN THESE FORMS MAY SUBJECT YOU TO PAYMENT OF ATTORNEY
FEES AND OTHER CIVIL PENALTIES.
Name and address of employee
Name and address of employer
Social Security Number (if known):
Attn:
(Insert name above)
1. I received the Earnings Withholding Order on
(date):
2. The employee is
a.
not employed by this employer (if not employed, omit items 2b through 6 and proceed to the declaration at the end of this
form).
now employed by this employer and in the last pay period had gross earnings of $ :
b.
3. The employee's pay period is
a.
daily
b.
c.
weekly
every two weeks
twice a month
e.
monthly
other (specify):
d.
f.
(IF YOU HAVE RECEIVED NO OTHER ORDERS THAT PRESENTLY AFFECT THIS EMPLOYEE'S EARNINGS, OMIT ITEMS 4, 5
AND 6, )
(Continued on reverse)
EMPLOYER'S RETURN
(Wage Garnishment)
Form Adopted by the
Judicial Council of California
WG-005 [Rev. July 1, 2007]
Code of Civil Procedure, ยง 706.126
www.courtinfo.ca.gov
EMPLOYER: You must complete both copies of this form and mail them to the levying officer within 15 days.
Please correct any errors in the mailing information above and provide any missing information, including the name
of the person to whom notices should be directed.
WG-005
Page 1 of 2
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
PLAINTIFF/PETITIONER:
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
LEVYING OFFICER (Name and Address):
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
TELEPHONE NO.:
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
CASE NUMBER:
LEVYING OFFICER FILE NO.:
FAX NO. (Optional):
DEFENDANT/RESPONDENT:
EMPLOYER'S RETURN
(Wage Garnishment)
AND PROCEED TO THE DECLARATION AT THE END OF THIS FORM.
SHORT TITLE:
LEVYING OFFICER FILE NO.:
COURT CASE NO.:
If you have received other orders th