Confidential Statement of Judgment Debtor's Social Security Number
California · Judicial Council of California · Effective January 1, 2012
This form is a private document used to give the court, the employer, and the person taking the money (levying officer) the Social Security Number of someone who owes money. It must be kept separate from public court records.
The court describes it as: Tells the court, employer, and levying officer the Social Security Number of a person who owes money.
Where this fits in a case
JudgmentStage: Judgment
This form is used when someone is trying to get an order to withhold wages because money is owed in a case.
Either party may file.
Official instructions
How-to guides published by the court for this form.
Common questions
- What is this form for?
- This form provides the Social Security Number of the person who owes money to the court, the employer, and the levying officer.
- Where should I file this form?
- The form states that this statement is confidential and should not be filed in a public court file.
- Who fills out this form?
- The form has sections for the attorney for the plaintiff/petitioner and the defendant/respondent, suggesting either party may be involved in filing it.
Revision history
No changes recorded since we started tracking this form on October 9, 2026. The current version took effect January 1, 2012.
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