WG-026 Claim of Exemption and Financial Declaration (State Tax Liability)

Source: https://www.courts.ca.gov/documents/wg026.pdf

WG-026 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

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TELEPHONE NO: FAX NO.: seeing what you entered on

ATTORNEY FOR STATE TAXPAYER/RESPONDENT: your form, please press the NAME OF COURT: Clear This Form button at the STREET ADDRESS: end of the form when finished. MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

APPLICATION OF (Name):

TAXPAYER/RESPONDENT

CASE NUMBER:

CLAIM OF EXEMPTION AND FINANCIAL DECLARATION

NAME OF STATE TAX AGENCY: TAX AGENCY NUMBER:

(Copy the information required above from the Application for Earnings Withholding Order for Taxes (form WG-020). The top left space is for your or your attorney's name and address.)

1. I need the following earnings to support myself or my family (check and complete item a or b): a. All earnings. b. $ each pay period.

2. Please send all papers to me my attorney at the address shown above following (specify):

3. In addition to the 25 percent minimum withholding, I am willing for the following amount to be withheld from my earnings during the withholding period: a. None b. Withhold: $ each pay period.

4. a. I am paid daily weekly every two weeks twice a month monthly.

   b. My gross pay is: $ per pay period.

   c. My take-home pay is: $ per pay period.

   d. My payroll deductions are (item and amount):

5. The following persons depend, in whole or in part, on me for support:

   Name Age Relationship to me Monthly income and its source

   a. Myself

   b.

   c.

   d.

   e.

6. The earnings of others listed in item 5 are now subject to wage assignments and Earnings Withholding Orders as follows (specify):

Form Adopted for Mandatory Use CLAIM OF EXEMPTION AND FINANCIAL DECLARATION Code of Civil Procedure,www.courtinfo.ca.gov§§ 706.051, 706.076 Judicial Council of California WG-026 [Rev. January 1, 2007] (Wage Garnishment-State Tax Liability)

WG-026

APPLICATION OF (Name): CASE NUMBER:

TAXPAYER/RESPONDENT

7. My monthly expenses are as follows: a. Rent or house payment and j. Entertainment and incidentals . . . . $ maintenance . . . . . . . . . . . . . . . . . . $ k. Transportation and auto expenses b. Food and household supplies . . . . . . $ (insurance, gas, repair) . . . . . . . . . . $ c. Utilities and telephone . . . . . . . . . . . $ l. Installment payments (insert d. Clothing . . . . . . . . . . . . . . . . . . . . . . $ total and list below in item 8) . . . . . . $ e. Laundry and cleaning . . . . . . . . . . . $ m. Other (specify): . . . . . . . . . . . . . . . . $ f. Medical and dental payments . . . . . .$ g. Insurance (life, health, accident, etc.) . . . . . . . . . . . . . . . . . .$ h. School, child care . . . . . . . . . . . . . . .$ i. Child, spousal support TOTAL MONTHLY EXPENSES (prior marriage) . . . . . . . . . . . . . . . . $ (add a through m) . . . . . . . . . . . . . . . . $

8. List payments on installment and other debts. Continued on Attachment 8. Creditor's name For Monthly payment Balance

9. What do you own? (State value.) a. Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . $ d. Real estate equity (addresses): . . $ b. Checking, savings and credit union accounts, etc. (list institutions): (1) $ (2) $ e. Other personal property (jewelry, (3) $ furniture, furs, stocks and bonds, etc. List separately): (4) $ c. Cars, other vehicles, and boat equity (list make, year of each): (1) $ (2) $ (3) $ Total for item e: . . . $

10. An Order Assigning Salary and Wages (for support) is now in effect as to my earnings. The amount payable under that order
    is: $ monthly.

11. Other facts that support this Claim of Exemption are (describe unusual medical needs, school tuition, expenses for recent family emergencies, or other unusual expenses to help the judge understand your budget): Continued on Attachment 11.

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) (SIGNATURE OF TAXPAYER) File this form with the clerk of the court and mail a copy to the tax agency as soon as possible. Keep a copy and take it with you to the court hearing. If you wish to obtain the advice of an attorney, you should do so at once.

WG-026 [Rev. January 1, 2007] CLAIM OF EXEMPTION AND FINANCIAL DECLARATION Page 2 of 2 (Wage Garnishment-State Tax Liability)

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