WG-021 Confidential Supplement to Application for Earnings Withholding Order for Taxes (State Tax Liability)

Source: https://www.courts.ca.gov/documents/wg021.pdf

To keep other people from seeing what you entered on your form, please press the Clear This Form button at the end of the form when finished. WG-021 CONFIDENTIAL APPLICATION OF (Name): CASE NUMBER:

TAXPAYER / RESPONDENT

CONFIDENTIAL STATEMENT OF TAXPAYER'S
SOCIAL SECURITY NUMBER

Supplement to Application for Earnings Withholding Order for Taxes (Form WG-020)
(Do not attach to Application)

This separate Confidential Statement of Taxpayer's Social Security Number contains the social security number of the taxpayer-respondent in the case referenced above. This supplement should be kept separate from the Application for Earnings Withholding Order for Taxes filed in this case, and should not be a public record.

INFORMATION ON TAXPAYER-RESPONDENT:

1. Name:

2. Social Security Number:

   TO COURT CLERK

   THIS STATEMENT IS CONFIDENTIAL. DO NOT FILE

   THIS CONFIDENTIAL STATEMENT IN A PUBLIC COURT FILE.

Form Adopted for Mandatory Use CONFIDENTIAL SUPPLEMENT TO APPLICATION Judicial Council of California WG-021 [Rev. January 1, 2007] FOR EARNINGS WITHHOLDING ORDER FOR TAXES (Wage Garnishment-State Tax Liability) For your protection and privacy, please press the Clear This Form button after you have printed the form. Save This Form Print This Form Clear This Form