Fill out California form WG-007/EJ-165 Financial Statement yourself (free)

Short title and case numbers

The box at the top of both pages. Copy it from the claim of exemption this form goes with (WG-006 or EJ-160).

Help with this step

This Financial Statement goes with a claim of exemption: WG-006 for wage garnishment (items 3b or 3c) or EJ-160 for a bank levy or other property (item 4). Court guides: wage garnishment · bank levy.

Short title

Often the names of the parties, for example Midland Credit v. Rosa Martinez.

Levying officer file no.

Court case no. (required)

People who depend on you

Item 1: “The following persons other than myself depend, in whole or in part, on me or my spouse for support.” Leave rows empty if they don’t apply.

Help with this step

Row a is your spouse (the form already prints “Spouse”). Rows b to e are other people. Type what you want printed in each box, in English.

a. Spouse

1a. Name

1a. Age

1a. Monthly take-home income & source

Write it as you want it to appear, for example: $1,400 – job at a store.

b. Another person

1b. Name

1b. Age

1b. Relationship to me

1b. Monthly take-home income & source

c. Another person

1c. Name

1c. Age

1c. Relationship to me

1c. Monthly take-home income & source

d. Another person

1d. Name

1d. Age

1d. Relationship to me

1d. Monthly take-home income & source

e. Another person

1e. Name

1e. Age

1e. Relationship to me

1e. Monthly take-home income & source

Monthly income

Item 2: “My monthly income”. Your pay stubs show your gross pay and deductions.

Help with this step

You type every amount, including the totals. Under a total we show what the lines you typed add up to; we never change what you typed.

2a. My gross monthly pay is $

Numbers only, like 1,250.00. The $ sign is already on the form.

2b. My payroll deductions are (specify purpose and amount):

(1) Federal and state withholding, FICA, and SDI $

(2) Purpose

(2) Amount $

(3) Purpose

(3) Amount $

(4) Purpose

(4) Amount $

My TOTAL payroll deduction amount is (add (1) through (4)) $

2c. My monthly take-home pay is (a minus b) $

2d. Other money I get each month from (specify source)

is $

2e. TOTAL MONTHLY INCOME (c plus d) $

What you own

Item 3: “I, my spouse, and my other dependents own the following property.”

Help with this step

Equity means what the car or home is worth minus what is still owed on it. Leave lines empty if they don’t apply.

3a. Cash $

3b. Checking, savings, and credit union accounts (list banks):

(1) Bank

(1) $

(2) Bank

(2) $

(3) Bank

(3) $

3b. Total $

3c. Cars, other vehicles, and boat equity (list make, year of each):

(1) Make, year

(1) $

(2) Make, year

(2) $

(3) Make, year

(3) $

3c. Total $

3d. Real estate equity $

3e. Other personal property (jewelry, furniture, furs, stocks, bonds, etc.) (list separately)

3e. $

Monthly expenses

Item 4: “The monthly expenses for me, my spouse, and my other dependents.”

Help with this step

Monthly amounts. Car payments and other installment payments are itemized in item 5 (next step).

4a. Rent or house payment and maintenance $

4b. Food and household supplies $

4c. Utilities and telephone $

4d. Clothing $

4e. Medical and dental payments $

4f. Insurance (life, health, accident, etc.) $

4g. School, child care $

4h. Child, spousal support (prior marriage) $

4i. Transportation & auto expenses (insurance, gas, repair) (list car payments in item 5) $

4j. Installment payments (insert total and itemize below in item 5) $

4k. Laundry and cleaning $

4l. Entertainment $

4m. Other (specify)

4m. $

4n. TOTAL MONTHLY EXPENSES (add a through m) $

Debts

Item 5: “I, my spouse, and my other dependents owe the following debts.” Up to six lines fit on the form.

Help with this step

For each debt: who you owe, what it is for, the monthly payment, the balance and whose debt it is. Leave lines empty if you don’t need them.

Debt 1

1. Creditor’s name

1. For

1. Mo. payments

1. Balance owed

1. Owed by (person’s name)

Debt 2

2. Creditor’s name

2. For

2. Mo. payments

2. Balance owed

2. Owed by (person’s name)

Debt 3

3. Creditor’s name

3. For

3. Mo. payments

3. Balance owed

3. Owed by (person’s name)

Debt 4

4. Creditor’s name

4. For

4. Mo. payments

4. Balance owed

4. Owed by (person’s name)

Debt 5

5. Creditor’s name

5. For

5. Mo. payments

5. Balance owed

5. Owed by (person’s name)

Debt 6

6. Creditor’s name

6. For

6. Mo. payments

6. Balance owed

6. Owed by (person’s name)

Other facts

Items 6, 7 and 8 on page 2.

Help with this step

Item 6 is in your own words. Check item 7 or 8 only if it is true; then write each person’s name and the monthly amount.

6. 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) (describe):

The form says: if more space is needed, attach a page labeled Attachment 6.

7. An earnings withholding order is now in effect with respect to my earnings or those of my spouse or dependents named in item 1 (specify each person’s name and monthly amount):

8. A wage assignment for support is now in effect with respect to my earnings or those of my spouse or dependents named in item 1 (specify each person’s name and monthly amount):

Item 9, names and date

The end of page 2. You (and your spouse, if item 9 says so) sign by hand after you print.

Help with this step

The form’s 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.” You sign under penalty of perjury, so everything must be true.

9. Check the one that is true (required)

My spouse has signed below.I have no spouse.My spouse and I are living separate and apart.

The form says: “I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.”

Date (optional: or write it by hand when you sign)

Your name, as it goes under your signature (required)

Check and download

Check every line. This is exactly what will be printed on the form. To change something, go back to that step.

Do this by hand after you print:

Sign page 2 by hand.
Your spouse signs page 2 by hand too.
Attach this form to your claim of exemption (WG-006 or EJ-160).

The PDF is made in your browser. Nothing is sent to the court.

Fill out the Financial Statement (WG‑007/EJ‑165) yourself

Short title and case numbers

People who depend on you

a. Spouse

b. Another person

c. Another person

d. Another person

e. Another person

Monthly income

2b. My payroll deductions are (specify purpose and amount):

What you own

3b. Checking, savings, and credit union accounts (list banks):

3c. Cars, other vehicles, and boat equity (list make, year of each):

Monthly expenses

Debts

Debt 1

Debt 2

Debt 3

Debt 4

Debt 5

Debt 6

Other facts

Item 9, names and date

Check and download

Do this by hand after you print:

Your Financial Statement is ready. What to do next

Do this by hand after you print:

Good to know