B. What was true when the judgment became enforceable?
2. What is true now?
C. Please report on the form:
a. If you were married at the date of the judgment, or if you were divorced;
b. If you were married at the time you made the sworn statement;
c. If you were legally separated;
d. The date you remarried or if you have no legal marital connection to your spouse(s); and
e. The date you separated.
F. How many times did you know your spouse to be a judgment debtor, creditor, or employee? If this information is
missing, check this box.
2. (1) Did you know that you or your spouse had a debt?
a. Yes
f. No
3. Do you want our agency to contact you or your spouse?
a. Yes, I want to be contacted by the agency;
b. Yes, my spouse consents to our contacting him or her;
c. Do you want to be contacted by my attorney or your attorney?
4. (2) Do you have any information about the information you or your spouse is required to submit to the agency? a. Yes.
5. Have you been served with the judgment? Have you been served with the written demand for payment of the judgment?
a. Yes
b. No
6. Were there any documents, such as court orders, orders of collection, or notices of claims and demands, that required you to submit information to the agency about this debt? (Your debt may not
result from default or judgment.) If so, report that information here also.
a. Yes
b. No
6. Did you file an application for a change of circumstances at one of our offices? When? How?
a. Yes;
b. No
C. If this information is missing, check here.
1. Can you verify that the creditor's name is the individual's name as indicated on the debt?
a. Yes, my address and phone number matches
b. No, but my address and phone number matches
2. Can you verify that the debt you've been told is more than 500, that you can no longer pay, that you are in foreclosure, or that defaulted upon your debt?
a. Yes.
b.
CA WG-007/EJ-165 2007-2024 free printable template
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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-007/EJ-165 SHORT TITLE LEVYING OFFICER FILE NO. COURT CASE NO. FINANCIAL STATEMENT Wage Garnishment Enforcement of Judgment 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. 1. The...
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