Form WG-007/EJ-165 at a glance
What it is: WG-007/EJ-165 is the FINANCIAL STATEMENT (Wage Garnishment-Enforcement of Judgment), a form adopted by the Judicial Council of California.
Who signs: NOTE: If you are married, this form must be signed by your spouse unless you and your spouse are living separate and apart. If this form is not signed by your spouse, check the applicable box on the reverse in item 9.
A filled-in Form WG-007/EJ-165 example: a single parent files the statement
How to fill out Form WG-007/EJ-165, box by box
1. The following persons other than myself depend on me or my spouse for support
List the persons other than you who depend, in whole or in part, on you or your spouse for support: NAME, AGE, RELATIONSHIP TO ME, and MONTHLY TAKE-HOME INCOME & SOURCE. Line a. is Spouse.
2. My monthly income
Enter your gross monthly pay in 2a.
b. Specify the purpose and amount of your payroll deductions. Line (1) is Federal and state withholding, FICA, and SDI.
Add (1) through (4) for your TOTAL payroll deduction amount. Your monthly take-home pay is a minus b.
d. Specify the source of other money you get each month. e. TOTAL MONTHLY INCOME is c plus d.
3. I, my spouse, and my other dependents own the following property
List the property that you, your spouse, and your other dependents own. Enter your cash in 3a.
b. List the banks for your checking, savings, and credit union accounts. c. List the make and year of each car, other vehicle, and boat equity.
d. If you own real estate, enter your Real estate equity. e. List separately your Other personal property (jewelry, furniture, furs, stocks, bonds, etc.).
4. The monthly expenses for me, my spouse, and my other dependents
In 4, enter the monthly expenses for you, your spouse, and your other dependents: 4 a. Rent or house payment and maintenance.
Enter Food and household supplies, Utilities and telephone, Clothing, Medical and dental payments, Insurance (life, health, accident, etc.), School, child care, Child, spousal support (prior marriage), Laundry and cleaning, and Entertainment.
For Transportation & auto expenses (insurance, gas, repair), list car payments in 5. For Installment payments, insert total and itemize in 5.
m. Specify any Other expense. n. TOTAL MONTHLY EXPENSES is a through m.
5. I, my spouse, and my other dependents owe the following debts
List the debts that you, your spouse, and your other dependents owe: CREDITOR'S NAME, FOR, MO. PAYMENTS, BALANCE OWED, and OWED BY (State person's name).
6. Other facts which support this Claim of Exemption
Describe other facts which support this Claim of Exemption (i.e., unusual medical needs, school tuition, expenses for recent family emergencies, or other unusual expenses to help your creditor and the judge understand your budget). If more space is needed, attach page labeled Attachment 6.
7. An earnings withholding order is now in effect
Check the box if an earnings withholding order is now in effect with respect to your earnings or those of your spouse or dependents named in 1, and specify each person's name and monthly amount.
8. A wage assignment for support is now in effect
Check the box if a wage assignment for support is now in effect with respect to your earnings or those of your spouse or dependents named in 1, and specify each person's name and monthly amount.
9. My spouse has signed below
Check My spouse has signed, I have no spouse, or My spouse and I are living separate and apart.
On page 2, you declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Enter the Date, type or print your name, and sign.
Your spouse signs on the second SIGN line: TYPE OR PRINT NAME OF SPOUSE and SIGNATURE OF SPOUSE.
Sources
[1] Form WG-007/EJ-165 (Rev. January 1, 2007), Financial Statement (Wage Garnishment-Enforcement of Judgment), Judicial Council of California (the Official source link on this page).