joint petition

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FA-4111V, 01/09 Joint Petition-Without Minor Children §767.215, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

of 4

Enter the name of the county in which you are filing this case.

STATE OF WISCONSIN, CIRCUIT COURT, COUNTY

Enter the wife’s name.

Enter the wife’s address.

For Official Use

On the far right, check divorce or legal separation.

In RE: The marriage of Joint Petitioner-Wife: First name Middle name Last name

Address

Address

City State Zip

and

Enter the husband’s name.

Enter the husband’s address.

Note: Leave case number blank; the clerk will add this.

Joint Petitioner-Husband: First name Middle name Last name

Address

Address

City State Zip

Joint Petition Without Minor Children

Divorce-40101 Legal Separation-40201

Case No.

A. We are providing the following information about the wife:

1. Date of birth 2. Immediately before filing this petition, the wife will have lived in this county for 30 days

or more. Yes No 3. Immediately before filing this petition, the wife will have lived in the state of Wisconsin

for 6 months or more. Yes No 4. The wife is currently on active duty as a member of the Armed Forces of the United

States of America or its allies. Yes No

B. We are providing the following information about the husband: 1. Date of birth 2. Immediately before filing this petition, the husband will have lived in this

county for 30 days or more. Yes No 3. Immediately before filing this petition, the husband will have lived in the state

of Wisconsin for 6 months or more. Yes No 4. The husband is currently on active duty as a member of the Armed Forces of

the United States of America or its allies. Yes No

Enter the wife’s date of birth [month, day, year].

For 2, 3 and 4, check yes or no. Military personnel: Please see Basic Guide to Divorce/Legal Separation.

Enter the husband’s date of birth [month, day, year].

For 2, 3 and 4, check yes or no. Military personnel: Please see Basic Guide to Divorce/Legal Separation.

PORTAGE

123 Main Street

Stevens Point Wisconsin 54481

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123 Main Street


July 20, 1978

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June 25, 1977

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Jane Doe

John Doe

SAMPLE

Joint Petition – Without Minor Children of 4 Case No. ________________


Page 2 of 4

C. We are providing the following marriage information:

1. We were married on (date) 2. We were married in (city) (state) 3. We are filing for:

a. Divorce: This marriage is irretrievably broken. b. Legal Separation: This marriage is broken and the reason we are requesting a

legal separation and not a divorce is

4. Previous Actions

This is the first time that either my spouse or I have filed for divorce or legal separation from each other in Wisconsin or in any other state:

a. Yes b. No: County

State Case No.

Has this case been dismissed? Yes No 5. This is the wife’s first marriage. Yes No

a. The wife was previously married to b. The marriage was terminated by: divorce. death.

c. Date of the divorce or death d. The divorce was granted in: Name of court City State e. The wife was also previously married to f. The marriage was terminated by: divorce. death.

g. Date of the divorce or death

h. The divorce was granted in: Name of court City State If the wife had more than 2 previous marriages, repeat 5e-5h on an additional sheet.

6. This is the husband’s first marriage. Yes No

a. The husband was previously married to b. The marriage was terminated by: divorce. death.

c. Date of the divorce or death d. The divorce was granted in: Name of court City State e. The husband was also previously married to f. The marriage was terminated by: divorce. death.

g. Date of the divorce or death h. The divorce was granted in:

Name of court City State If the husband had more than 2 previous marriages, repeat 6e-6h on an additional sheet.

Enter the date [month, day, year], city, and state in which you were married.

Check yes or no. If no, respond to 5a-5d with information about the wife’s most recent previous marriage.

If the wife had an additional previous marriage, respond to 5e-5h.

Check yes or no. If no, respond to 6a-6d with information about the husband’s most recent previous marriage.

Check a or b. If b, explain why you are filing for a legal separation and not a divorce.

If the husband had an additional previous marriage, respond to 6e-6h.

Check a or b. If b, enter the county and state in which it was filed, the case number assigned to it and check yes or no to indicate if the case has been dismissed.

June 12, 2004

Stevens Point Wisconsin

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Page 3 of 4

D. We are providing the following information regarding our children:

1. a. No children were born to or adopted together by us before or during our

marriage. b. All children, who are currently age 18 or older, born to the wife during the

marriage include: Name of Child Date of Birth

2. To the best of our knowledge, the wife in this marriage:

a. is currently pregnant. (An attorney [guardian ad litem] for the unborn child will be required if the husband is not the father.)

b. is not currently pregnant.

3. We have made written agreements or received orders from the court about some or all of the matters in this action such as maintenance (spousal support) or property division.

a. Yes, and we have attached a copy of the written agreement to this Petition. b. No

We consent to jurisdiction and waive service of summons. WE ASK THAT THE COURT:

1. Grant a judgment as requested. 2. Enter an order granting maintenance. Yes No 3. Enter other orders as it deems just and equitable.

ACTS PROHIBITED BY STATUTE In accordance with § 767.117 Wis. Stats., neither joint petitioners to this divorce or legal separation action can participate in any of the following activities while this action is pending: 1. Harassing, intimidating, physically abusing or imposing any restraint on the personal liberty of the other party or a minor child of either of the parties. 2. Encumbering, concealing, damaging, destroying, transferring, or in any other way disposing of property owned by either or both of the parties, without the consent of the other party or an order of the court or the Circuit Court Commissioner, except in the usual course of business, in order to secure necessities or in order to pay reasonable costs and expenses of the action, including attorney fees. A VIOLATION OF THE ABOVE PROHIBITIONS MAY RESULT IN PUNISHMENT FOR CONTEMPT, WHICH MAY INCLUDE MONETARY PENALTIES, IMPRISONMENT, AND OTHER SANCTIONS AS PROVIDED FOR IN SEC. 785.04 WIS. STATS. These PROHIBITIONS apply until the action is dismissed, a final judgment in the action is entered, or the court orders otherwise.

Check a or b. If b, write the names and dates of birth of all adult children born to the wife during the marriage.

If you are requesting maintenance (spousal support) at this time, check yes. If not, check no.

Check a or b. If a, attach a copy of the written agreement to this petition.

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Page 4 of 4

The wife must sign and print her name. She must enter the date on which she signed her name. Note: This signature does not need to be notarized.

�

Signature of Wife

Print or Type Name

Date

The husband must sign and print his name. He must enter the date on which he signed his name. Note: This signature does not need to be notarized.

�

Signature of Husband

Print or Type Name

Date

John Doe

Jane Doe

SAMPLE

PRINT in BLACK ink

GF-179, 03/12 Confidential Petition Addendum §§767.215(5), and 767.54, Wisconsin Statutes

This form shall not be modified. It may be supplemented with additional material.

Enter the name of the

county in which this case

is filed.

STATE OF WISCONSIN, CIRCUIT COURT,

COUNTY

For Official Use

This form is used for

family and paternity

case types. Some

information may not

apply to your case.

Petitioner:

First name Middle name Last name

Respondent:


Confidential Petition Addendum

Enter the case number and

child support IV-D KIDS

number, if known.

Case No.

IV-D KIDS Case No.

1. Parties

A. Wife/Mother Name:

Date of Birth: SS#: Phone No.

B. Husband/Father/Alleged Father Name:


C. Other party (if any):


See attached

2. Children

A. All minor children born to or adopted together by the parties in this action before or

during the marriage/relationship are:

None

Name of Minor Child Date of Birth SS#

See attached

B. If this is a divorce or legal separation, list other minor children born to the wife during this

marriage, but not fathered by the husband:

None

Name of Minor Child Date of Birth SS#

See attached

The party(s) filing this

addendum must sign and

print your name and date

the document.

Signature Signature

Print or Type Name Print or Type Name Print or Type Name

Date Date

Enter the name, date of

birth [month, day, year],

and social security

number of each minor

child. If there are no

minor children, check

none. Attach additional

pages if necessary.

Enter the name, date of

birth [month, day, year],

and social security

number of each party.

PORTAGE

Jane Doe07/20/1978 (323) 962-8600

John Doe06/25/1977 (323) 962-8600

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John Doe Jane Doe

Jane Doe

John Doe

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✔SAMPLE

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FA-4151V, 02/10 Marital Settlement Agreement Without Minor Children §767.34, Wisconsin Statutes

This form shall not be modified. It may be supplemented with additional material. Page 1 of 7 - 1 -



is filed.


COUNTY

For Official Use


petitioner. If joint

petitioners, enter the name

of the wife.

In RE: The marriage of

Petitioner/Joint Petitioner-Wife:


and

Marital Settlement

Agreement Without Minor Children

Divorce-40101

Legal Separation-40201

Case No.


respondent. If joint


of the husband.

Respondent/Joint Petitioner-Husband:


Check divorce or legal

separation.

Enter the case number.

Warning: Subject to court approval, the terms of this agreement will be included in your judgment of divorce or legal separation. Be sure you understand it completely. Some portions of this agreement cannot be changed after the court approves it, even if you did not understand or expect how it would affect you. You may wish to speak with a lawyer before you sign this agreement to be sure you are fully aware of the laws that may apply to you.

WE AGREE AS FOLLOWS:

A. MARITAL RELATIONSHIP

1. Divorce. This marriage is irretrievably broken.

2. Legal Separation. This marriage is broken and the reason we are requesting a legal

separation and not a divorce is

B. MAINTENANCE (Spousal Support)

1. For the Wife:

a. The wife gives up her right to receive maintenance. She understands that by giving up

maintenance at this time, she may never ask for maintenance.

b. The wife is not requesting maintenance at this time, but leaves open her right to request it

until . Her right to request maintenance is limited to

1. the following circumstance(s) only:

2. any appropriate substantial change in circumstance.

c. The husband shall pay maintenance to the wife in the amount of $ per

month beginning , 20 . Maintenance shall end 20

, or until the wife remarries, dies, or by court order,

whichever comes first.

2. For the Husband:

a. The husband gives up his right to receive maintenance. He understands that by giving

up maintenance at this time, he may never ask for maintenance.

b. The husband is not requesting maintenance at this time, but leaves open his right to

request it until . His right to request maintenance is limited to

1. the following circumstance(s) only:

2. any appropriate substantial change in circumstance.

c. The wife shall pay maintenance to the husband in the amount of $ per month

beginning , 20 . Maintenance shall end , 20 ,

or until the husband remarries, dies, or by court order, whichever comes first.

In A, check 1 or 2.

If 2, enter the reason you

are asking for a legal

separation and not a

divorce.

In 2, check a, b, or c. If b, enter a date and choose 1 or 2. If 1, enter the reasons. If c, enter the maintenance amount and the date the payments should begin and end.

In B.1, check a, b, or c. If b, enter a date and choose 1 or 2. If 1, enter the reasons. If c, enter the maintenance amount and the date the payments should begin and end.

PORTAGE

Jane Doe

John Doe

SAMPLE

Marital Settlement Agreement Without Minor Children Page 2 of 7 Case No.


This form shall not be modified. It may be supplemented with additional material. Page 2 of 7

3. Payments shall be made

a. no payments are ordered.

b. to the Wisconsin Support Collections Trust Fund (WI SCTF) at Box 74200, Milwaukee,

Wisconsin 53274-0200

1. directly from the payer to WI SCTF (only allowable if self-employed).

2. by income assignment from the payer’s employer as indicated below:

Employer name

Address of payroll office

City State Zip

Phone Fax

4. Arrearages for Previously Ordered Maintenance. The parties agree to handle the

maintenance arrears as follows:

a. No maintenance was previously ordered. There is no amount due.

b. The party has paid all maintenance as ordered. There is no amount due.

c. If there are any arrearages for maintenance now or at the time of the final hearing,

those arrearages are waived and the court financial record shall be set at zero.

d. As currently reflected in the WI SCTF KIDS computer system and shall be paid through

monthly income withholding by the WI SCTF in the amount of $

beginning , 20 . The arrears balance shall earn interest at the rate

of % per year until the arrearages are paid in full.

e. The arrears shall be set at $ and paid through

1. a one-time payment to the WI SCTF made by (Date) .

2. monthly income withholding by the WI SCTF in the amount of $

beginning , 20 . The arrears balance shall earn interest

at the rate of % per year until the arrearages are paid in full.

f. Shall be determined by the court at the time of the final hearing.

C. MEDICAL INSURANCE No later than the date of the final hearing, each party shall notify the other party in writing of the availability of COBRA or other continuation benefits under their current health care policy.

D. DEBTS AND LIABILITIES

The following is a listing of ALL the debts and liabilities that we presently owe (both individually

and as a couple) and who we agree shall be responsible for the payment of each debt:

Payment for

Payment to

(Creditor)

Balance

Due

Paid by

Wife

Paid by

Husband

Shared

Equally

Mortgage $

Mortgage $

Car 1 $

Car 2 $

Car 3 $

Loans-Student $

Loans-Personal $

Loans-Other $

Credit Card 1 $

Credit Card 2 $

Credit Card 3 $

Credit Card 4 $

Other $

Other $

Other $

Other $

See attached

In D, for each debt owed

individually and jointly,

write the name, current

balance, and check who

will be responsible for

payment.

NOTE: Any and all

debts disclosed on the

parties’ Financial

Disclosure Statements

that are still unpaid

should be included here

and divided between the

parties. Any new debts

incurred should also be

listed and divided.

If more space is

necessary, attach

additional sheets.

In 3, check a or b.

If b, check 1 or 2. If 2,

enter the employer

information.

NOTE: An arrearage is

an amount ordered that

has not been paid and is

overdue.

In 4, check a, b, c, d, e or

f.

If d, enter the monthly

payment amount, date

payments begin, and the

interest rate percentage

for arrearages.

If e, enter the amount of

the arrears balance and

check 1 or 2. If 1, enter

the date of the one-time

payment. If 2, enter the

amount of the monthly

payment, the date

payments begin, and the

interest rate percentage

for arrearages.

USA Inc.

Any and all debts in his name alone

Any and all debts in her name alone

7,500.00 ✔SAMPLE




The parties agree and understand:

Each party assigned a debt shall be fully responsible for that obligation and shall not make any demands upon the other party concerning that debt.

Any debt not listed shall be the responsibility of the party who incurred the debt.

Creditors are NOT bound by this agreement and that each party remains liable to creditors for all marital debts.

Any party who suffers a loss because of a failure of the other party to pay an assigned debt may enforce that obligation by a motion or an order to show cause) for contempt of court.

E. PERSONAL PROPERTY DIVISION

1. Division. The parties agree to the final personal property division as indicated below:

List the property and check if the wife or husband will have permanent use of the property once the

divorce/legal separation is final.

Who will have possession?

Wife = W Husband = H

Household Items W H

Automobiles

Year, Make, Model W H

Life Insurance

Name of Company & Policy # W H

Business Interests

Name of Business & Address W H

Securities: Stocks, Bonds, Mutual Funds, Commodity Accounts

Name of Company & # of shares W H

Pension, Retirement Accounts,

Deferred Compensation, 401K Plans, IRAs, Profit Sharing, etc.

Name of Company & Type of Plan

W H

Cash and Deposit (Savings & Checking) Accounts

Name of Bank or Financial Institution W H

In E, complete this

section with as much

detail as possible.

NOTE: There are two

types of property. “Real

estate” includes such

things as homes and land.

“Personal property”

includes all other things

such as vehicles, clothing

and other personal items,

furniture, bank accounts,

and retirement or

investment accounts.

NOTE: If you have

already divided the

property, you must still

disclose how you

divided it.

NOTE: Any and all

assets disclosed on the

parties’ Financial

Disclosure Statements

should be included here

and divided between the

parties.

If the parties have

disposed of an asset from

the time the Financial

Disclosure was done, to

the final hearing, please

indicate what was

disposed and what

happened to it.

SAMPLE




Other Personal Property

Description of Asset W H

See attached

2. Exchange. The following items still need to be exchanged between the parties:

a. None. All personal property has already been exchanged to the satisfaction of both

parties.

b. List of items:

The exchange of personal property shall be made by (Date)

according to the following arrangements:

Any item of personal property not listed in #2(b) above shall be awarded to the party

who has possession at the time of the final hearing.

F. DIVISION OF REAL ESTATE 1. Neither party owns any real estate at this time. 2. One or both parties own real estate at this time. a. Primary Residence. The parties own a primary residence located at:

Address

City State Zip

Parcel Identification Number (Tax Key Number)

Attached is a legal description of this property.

1. This primary residence shall be awarded to the

A. wife

B. husband

and that party shall be responsible for outstanding financial obligations, and

the other party shall be held harmless from any liability. Other provisions

including refinancing requirements, if any:

See attached

2. This residence shall be placed on the market for sale. A. Pending sale, the residence shall be occupied, used, or managed by 1. wife. 2. husband. 3. shared equally.

4. other:

B. Pending sale, the mortgage, taxes, and insurance shall be paid by

1. wife.

2. husband.

3. shared equally.

4. other:

C. Pending sale, any necessary repairs, special assessments and other

sale-related expenses shall be paid by

1. wife.

2. husband.

3. shared equally.

4. other:

The money from the sale of this residence shall be used to pay the usual

costs of a sale and prorations, and any balance on the existing mortgage.

Upon payment of all costs, the proceeds left from the sale shall be divided

between the parties as follows:

a. The wife to receive %.

b. The husband to receive %.

In 2, check a or b. If b,

list the items and

indicate when and how

any exchange of

personal property will

take place.

If more space is necessary, mark the box and attach additional sheets.

In F, check 1 or 2. If 2, and the parties

own a primary

residence, check a. If a, enter the address

and Parcel

Identification Number,

which can be found on

your real estate tax

bill. Attach a copy of the

legal description. Check 1 or 2. If 1, check A or B and

enter other provisions,

if any.

If 2, check 1, 2, 3, or 4

in A, B, and C for the

responsibility for other

expenditures that

occur while the

property is being sold. Enter the percentage

each party shall

receive in a and b.

The total amount must

equal 100 %.

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Any and all personal property, tangible and intangible, in his sole possessionAny and all personal property, tangible and intangible, in her sole possession

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SAMPLE




b. Other Real Estate. One or both of the parties own additional real estate, including

any timeshare interests, which is disclosed and divided as set forth in the attached

Schedule A.

Transfer of Title. Both parties understand that this marital settlement agreement alone will

not transfer title to one party or the other, but such a transfer requires a fully executed Quit

Claim Deed and a Wisconsin Real Estate Transfer Return signed by the parties. The

party awarded a parcel of real estate shall be responsible for having the necessary

documents prepared. G. EQUALIZATION OF MARITAL PROPERTY DIVISION.

1. No payment is required to be made to equalize the marital property division because a. the property and debt division are equalized to the satisfaction of the parties. b. equalization has been accomplished through a division of real estate sale proceeds. 2. A payment of $ is required to equalize the marital property division.

a. This payment shall be made by the

1. wife to the husband.

2. husband to the wife. b. This payment

1. was made. 2. shall be made in a lump sum payment no later than (Date) , 20 . 3. shall be paid in the amount of $ per month beginning , 20 .

c. The amount shall earn interest until paid in full at the rate of % per year from the date

1. of the final hearing.

2. the payment was due.

H. TAXES.

1. Year of Divorce/Legal Separation.

The parties agree to file their income tax returns for the year of the divorce/legal

separation consistent with the rules of the IRS, Wisconsin Department of Revenue, and

Wisconsin’s Marital Property law.

The parties understand that their marital status on the last day of the year determines

their filing status for that year, whether married or single.

The parties acknowledge that each is responsible for seeking tax advice from a tax

professional with regard to issues of this divorce/legal separation.

2. Years Before Divorce/Legal Separation.

a. Tax returns for all previous years have been filed.

b. The parties agree to file returns for the previous tax years as follows:

1. share preparation expenses, tax liability and/or refund equally.

2. Other:

I. LEGAL NAME RESTORATION.

1. Neither party requests the right to use a former legal surname.

2. The wife requests the right to use a former legal surname of .

3. The husband requests the right to use a former legal surname of .

Note: If this is an action for legal separation, the court cannot allow a spouse to resume a former legal surname unless and until the judgment is converted to a divorce.

J. OTHER AGREEMENTS.

We understand that any oral agreements are not enforceable by the court.

1. We have no other agreements, written or oral, concerning this marriage.

2. We have attached written agreements concerning this marriage, copies of which are

attached.

In 2, check a or b.

If b, check 1 or 2.

If 2, indicate how the

parties agree to handle

the filing (expense and

refund, if any).

In I, check 1, 2, or 3.

If 2 or 3, enter the

former surname.

In J, check 1 or 2.

If 2, attach any

additional agreements.

In G, check 1 or 2.

If 1, check a or b.

If 2, enter the amount.

In a, check 1 or 2.

In b, check 1, 2 or 3.

If 2, enter the date

[month, day, year].

If 3, enter the amount

and date.

In c, enter the

percentage and check

1 or 2.

If the parties own

other real estate

(including any

timeshare interests),

check b, complete the

attached Schedule A

found at the end of this

document.

Eod

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SAMPLE




K. AGREEMENTS and UNDERSTANDINGS. We understand and agree:

We could each get an attorney to review this agreement.

This form was provided as a convenience and may NOT cover all issues.

This agreement may have tax consequences and that seeking tax advice is suggested.

We have each fully disclosed each of our income, debts, assets and liabilities to each other.

Maintenance is deductible by the payer and taxable to the payee.

Any court order regarding the division of property is final as of the date of the final hearing and can never be changed.

There are certain legal presumptions under Wisconsin law, such as marital property should be divided 50/50.

L. VOLUNTARY EXECUTION / NATURE OF AGREEMENT. We assume equal responsibility for the entire content of this agreement. We have entered into this marital settlement agreement freely and voluntarily and not because of any undue influence. In some instances, the agreement represents a compromise of disputed issues. We believe the terms to be fair and reasonable under the circumstances. We acknowledge that there may be substantial legal and tax implications with regard to this agreement. We understand that lack of knowledge of the law may not be sufficient to convince the court that relief from these provisions is required. We acknowledge that each of us has the right to seek the advice of our own personal attorney.

M. MUTUAL / GENERAL RELEASE. We release each other from any claim of any nature that may exist. Neither of us may, at any time hereafter, sue the other, or our heirs, personal representatives, and assigns, for the purpose of enforcing any or all of the rights relinquished and/or waived under this agreement. We agree that in the event any suit shall be commenced, this release, when pleaded, shall constitute a complete defense to any such claim or suit so instituted by the other party. We understand that this mutual and general release shall not become effective until this Marital Settlement Agreement is approved by the court.

N. FULL DISCLOSURE AND RELIANCE. We warrant to each other that there has been an accurate, complete, and current disclosure of all income, assets, debts, and liabilities. We understand and agree that deliberate failure to provide complete disclosure constitutes perjury under §767.27, Wis. Stats. and a fraud upon the court. The property referred to in this agreement represents all the property in which either party has any interest. This agreement is based on our financial disclosure statements. We relied on these financial representations when entering into this agreement.

O. RESTRAINING ORDER. We agree to never interfere with the personal liberty of the other, or to go on the premises occupied by the other as a residence except with permission of that party.

P. EXECUTION OF DOCUMENTS. Now, or in the future, on demand, we agree to execute and deliver any and all documents that may be necessary to carry out the terms and conditions of this agreement.

Q. DIVESTING OF PROPERTY RIGHTS.

Except as otherwise provided for in this agreement, we give up all rights to the property awarded to the other.

All property awarded to a party shall be the separate property of that party.

We shall have the right to manage our separate property as if we had never been married.

SAMPLE




R. SURVIVAL OF AGREEMENT AFTER JUDGMENT. We agree that the provisions of this agreement shall survive any subsequent judgment of divorce and shall have independent legal significance. This agreement is a legally binding contract, entered into for good and valuable consideration. It is contemplated that in the future either of us may enforce this agreement in this or any other court of competent jurisdiction.

S. JURISDICTION. This county shall have jurisdiction for all disputes unless otherwise agreed to in writing or as provided under Wisconsin Statutes.

T. APPROVAL OF COURT REQUIRED. We have read this agreement and agree with its terms. We submit this Marital Settlement Agreement to the court for approval, and request the court to incorporate its terms in the final judgment. Once approved by the court, we understand that either of us may enforce this agreement in this or any other court of competent jurisdiction.

U. WAIVER OF APPEARANCE.

We agree that the court may proceed with the final hearing without further notice, and consent to

judgment being entered on the petition, pursuant to the terms of this Marital Settlement

Agreement even if the respondent or one of the joint petitioners does not appear.

The wife must sign

and print her name.

Enter the date on

which she signed her

name.

Note: This signature

does not need to be

notarized.

► Wife

Print or Type Name

Date

The husband must

sign and print his

name.

Enter the date on

which he signed his

name.

Note: This signature

does not need to be

notarized.

► Husband

Print or Type Name

Date

John Doe

Jane Doe

SAMPLE

PRINT in BLACK ink

FA-4132 Pro Se, 10/06 Request for Status Conference §802.10, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

Page 1 of 1

Enter the name of the county in which this case is filed.


Check marriage or Paternity. If Paternity, enter initials of child. Enter the name of the petitioner. If joint petitioners, enter the name of the wife.

For Official Use

In re the Marriage Paternity of: Petitioner/Joint Petitioner-Wife: First name Middle name Last name

and

Enter the name of the respondent. If joint petitioners, enter the name of the husband.


Respondent/Joint Petitioner-Husband: First name Middle name Last name

Request for Status

Conference

Case No.

To:

Name

Address

Address

City State Zip

I request a status conference in this case. The parties are required to attend the status conference, which is scheduled:

Before: Circuit Court Judge Location:

Date:

Time: a.m./p.m.

If you need help in this matter because of a disability, please call:

Sign and print your name. Enter the date on which you signed your name. Note: This signature does not need to be notarized.

Signature

Print or Type Name

Date

Note: A copy of this request must be served by mail on all other parties.

For Court Use Only: The Clerk will complete this section.

Enter the name and address of the other spouse/parent.

PORTAGE

Jane Doe

John Doe

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SAMPLE

PRINT in BLACK ink

FA-4139V, 01/08 Financial Disclosure Statement §767.127, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

Page 1 of 8



Enter the name of the petitioner. If joint petitioners, enter the name of the wife.

For Official Use

On the far right, check Petitioner/Joint Petitioner-Wife or Respondent/Joint Petitioner-Husband

In RE: The marriage of: Petitioner/Joint Petitioner-Wife: First name Middle name Last name

and




Financ ial Disclosure Statement of :

Petitioner/Joint Petitioner-Wife Respondent/Joint Petitioner-

Husband

Case No.

This form must be filed with the court within the time period set by the court but no later than 90 DAYS after the service of the Summons and Petit ion on the respondent (spouse) or the filing of a Join t Petit ion. Failure by either party to complete and file this form or attachments as required will authorize the court to accept the statement of the other party as the basis for its decisions. Delib erate failu re to provide complete disclosure is perjury.

1. PROOF OF INCOME � Attach a statement reflecting income earned to date for the current year. � Attach most recent W-2 Statement. 2. GENERAL INFORMATION

Name Address Address City State Zip Phone (day) Phone (evening) Alternative Phone: Social Security Number Occupation Employer Address Address City State Zip Phone Fax Payroll Office Same as employer Address Address City State Zip Phone Fax

PORTAGE

Jane Doe

John Doe

✔

John Doe

123 Main Street

Stevens Point Wisconsin 54481(323) 962-8600

Electrician

XYZ LLC

345 Main Street

Wisconsin 54467Anytown(323) 962-8600

SAMPLE

Financial Disclosure Statement Page 2 of 8 Case No. ____________


Page 2 of 8

3. MEMBERS OF YOUR HOUSEHOLD Enter the name and relationship of all people living in your household. Check yes or no to identify if they contribute to payment of household expenses. � Name

I live alone

Relationship This person helps pay expenses

Yes No � � � � � � � � � � � � � � � � � � � � � �

4. MONTHLY INCOME Income from wages / salary is received (check one):

To calculate monthly gross income use the multiplier shown: weekly -multiply weekly income by 4.3 every other week (bi-weekly) -multiply bi-weekly income by 2.15 monthly twice a month-multiply semi-monthly income by 2

MONTHLY GROSS INCOME

� � �1. Gross monthly income (before taxes and deductions) from salary and wages, including commissions, allowances and overtime. (See above how to calculate.)

�

� � � Pensions and retirement funds received �� Social Security benefits received �� Disability and Unemployment Insurance received �� Public Assistance Funds received �� Interest and Dividends received � � �7. Child Support and maintenance (spousal support) received from any prior

marriage/relationship �

� � � Rental payments received (from property you rent to others) �� Bonuses received �� Other sources of income received: (please specify) ��

Total Gross Income (add lines 1-12) MONTHLY DEDUCTIONS14. Number of tax exemptions claimed �

15. Monthly federal income tax withheld 16. Monthly state income tax withheld �17. Social Security 18. Medicare �19. Medical insurance �20. Other insurances �21. Union or other dues �22. Retirement or pension fund �23. Savings plan �24. Credit union �25. Child support or spousal support payments �26. Other deductions: (please specify) �27. �28. Total Monthly Deductions (add lines 14 – 27) �

MONTHLY NET INCOME (subtract line 28 from line 13)

$4,309.38$0.00$0.00$0.00$0.00$0.00

$0.00$0.00$0.00

$4,309.38

$685.58$259.05$281.24$65.78$0.00$0.00$0.00$2,800.00$0.00

$0.00

$4,091.65

$217.73

SAMPLE



Page 3 of 8

5. ANTICIPATED MONTHLY EXPENSES

My Monthly Expenses �1. Rent or mortgage payment (primary residence) �2. Real Estate Property taxes (residence) �3. Repairs and maintenance (including maintenance of appliances and furnishings) �4. Food (include eating out) and household supplies �5. Utilities (electricity, heat, water, sewage, trash) �6. Telephone (local, long distance & cellular) �7. Cable and Internet Services �8. Laundry and dry cleaning �9. Clothing and shoes �10. Medical, dental and prescription drug expenses (not covered by insurance) �11. Insurance (life, health, accident, auto, liability, disability, homeowner’s or renter’s-

excluding insurance that is paid through payroll deductions) �

�

12. Childcare (babysitting and day care) �13. Child support or spousal support payments (due to previous marriage or relationship)

(Exclude payments made through payroll deductions) �

�

14. School expenses (child and adult education) �15. Entertainment (include clubs, social obligations, travel, recreation) �16. Incidentals (grooming, tobacco, alcohol, gifts, holidays and special occasions) �17. Transportation (other than automobile) �18. Auto payments (loans/leases) �19. Auto expenses (gas, oil, repairs, maintenance) �20. Newspapers, magazines, books �21. Care and maintenance of pets (food, vet, grooming) �22. Payments to any dependents not living in your home and not included in a category

above (including college age children) �

�

23. Hobbies �24. Other taxes than those listed above (exclude payroll deductions) �25. Other expenses (include expenses of other real properties owned, professional

services such as counseling and tax/legal advice, etc) �

�

Other Monthly installment payments: �26. Mortgage (other than primary mortgage) �27. Other vehicle payments �28. Credit card debt (total minimum monthly payments) �29. Court ordered obligations �30. Student loans �31. Personal loans � � TOTAL MONTHLY EXPENSES (Add lines 1-31) �

�

�

�

�

$0.00$888.00

$0.00

$200.00

$208.00

$0.00$0.00

$0.00$0.00

$0.00

$15.00

$0.00

$0.00

$0.00$0.00$0.00

$0.00$0.00

$0.00$0.00

$0.00

$0.00

$0.00

$1,311.00

SAMPLE



Page 4 of 8

�

6. ASSETS: List ALL assets that you own individually and together with your spouse without regard to how they have been or will be divided later.

If you do not have assets in an asset category, write “none” under the heading and enter “zero” in the estimated value column. If you need more space, please attach additional sheets.

W = Wife H=Husband

B=Both

Ownership or Title Held by

Current Possession

Household Items W H B W H B

Amount Owed Estimated

Value Today

Household furniture & accessories

Household appliances

Kitchen equipment

China, silver, crystal

Jewelry

Clothing

Antiques

Art

Electronic equipment

Sports equipment

Recreational vehicles, boats

Tools

Other

Automobiles: Year, Make, Model

Amount Owed

Estimated Value Today

SAMPLE



Page 5 of 8

Ownership or Title held by W = Wife H=Husband B=Both


Name of Company & # of shares W H B

Value Today

Life Insurance Name of Company & Policy #

Beneficiary Face Amount Cash Value

Today ��

� � �

�

� � �

��

� � �

��

� � �

Cash and Deposit (Savings and Checking) Accounts

Name of Bank or Financial Institution

Type of Account

Account # Last 4 digits

Balance Today

Pension, Retirement Accounts, Deferred Compensation, 401K

Plans, IRAs, Profit Sharing, etc. Name of Company & Type of Plan

% Vested if known

Date of Valuation Value Today

SAMPLE



Page 6 of 8

Business Interests Name of Business & Address

W H B Type of

Business % of Ownership

Value MINUS Indebtedness

Other Personal Property Description of Asset

Type of Property

Value

Ownership Acquired by Date Acquired Value Today Assets Acquired

Description of Asset G - Gift

I - Inherited B - Before Marriage

W H B G I B

Real Estate Parcel 1 Parcel 2 Parcel 3

Type of Property

Address: street, city, state

Current Fair Market Value

Current Mortgage Balance

Other Liens

SAMPLE



Page 7 of 8

7. MEDICAL, HOMEOWNERS/RENTERS, AUTOMOBILE, OTHER INSURANCE

What type of insurance policies do you have?

Name of Company, Group # & Policy # W H B

Type of Insurance

Date Issued

��

�

8. DEBTS: List ALL debts that you owe individually and together with your spouse without regard to who will

be responsible for payment later.

If there are additional DEBTS, please attach a separate sheet of paper with the creditor’s name and address, the type of obligation, who pays (W, H, B) and the current balance.

Who Currently Pays Creditor’s Name & Address

Type of Obligation

W H B

Monthly Payment

Current Balance

XYZ Health Plan, policy number ending in 5555 ✔ Medical

✔USA Inc. 7,500.00397.03Auto Loan

SAMPLE



Page 8 of 8

�

�

9. DISPOSAL OF ASSETS Did you dispose of any assets (sold, given away, or destroyed) in the 12 months before the case was filed?

Yes No If yes, complete chart below:

�� "! �� # $%��! �'& � ��(� ��*) ��#,+ ��-�� "! �� #

� � �

� � �

� � �

� � �

10. CURRENT LITIGATION

Are you a party in any other lawsuit or litigation? Yes No If yes, identify the lawsuit or litigation.

11. BANKRUPTCY

Have you ever filed for bankruptcy? Yes No If yes , identify the following: Type of filing Date of filing Current status

12. DECLARATION

I declare under the penalty of perjury that the above, including all attachments, is true and correct as of the date signed below.


Signature

Print or Type Name

Date

John DoeSAMPLE

PRINT in BLACK ink


Page 1 of 8



Enter the name of the petitioner. If joint petitioners, enter the name of the wife.

For Official Use

On the far right, check Petitioner/Joint Petitioner-Wife or Respondent/Joint Petitioner-Husband

In RE: The marriage of: Petitioner/Joint Petitioner-Wife: First name Middle name Last name

and




Financ ial Disclosure Statement of :

Petitioner/Joint Petitioner-Wife Respondent/Joint Petitioner-

Husband

Case No.

This form must be filed with the court within the time period set by the court but no later than 90 DAYS after the service of the Summons and Petit ion on the respondent (spouse) or the filing of a Join t Petit ion. Failure by either party to complete and file this form or attachments as required will authorize the court to accept the statement of the other party as the basis for its decisions. Delib erate failu re to provide complete disclosure is perjury.

1. PROOF OF INCOME � Attach a statement reflecting income earned to date for the current year. � Attach most recent W-2 Statement. 2. GENERAL INFORMATION

Name Address Address City State Zip Phone (day) Phone (evening) Alternative Phone: Social Security Number Occupation Employer Address Address City State Zip Phone Fax Payroll Office Same as employer Address Address City State Zip Phone Fax

PORTAGE

Jane Doe

John Doe

✔

Jane Doe

123 Main Street

Stevens Point Wisconsin 54481(323) 962-8600

Dental Assistant

ABC DDS

345 Main Street

Wisconsin 54467Plover(323) 962-8600

SAMPLE



Page 2 of 8

3. MEMBERS OF YOUR HOUSEHOLD Enter the name and relationship of all people living in your household. Check yes or no to identify if they contribute to payment of household expenses. � Name

I live alone

Relationship This person helps pay expenses

Yes No � � � � � � � � � � � � � � � � � � � � � �

4. MONTHLY INCOME Income from wages / salary is received (check one):

To calculate monthly gross income use the multiplier shown: weekly -multiply weekly income by 4.3 every other week (bi-weekly) -multiply bi-weekly income by 2.15 monthly twice a month-multiply semi-monthly income by 2

MONTHLY GROSS INCOME

� � �1. Gross monthly income (before taxes and deductions) from salary and wages, including commissions, allowances and overtime. (See above how to calculate.)

�

� � � Pensions and retirement funds received �� Social Security benefits received �� Disability and Unemployment Insurance received �� Public Assistance Funds received �� Interest and Dividends received � � �7. Child Support and maintenance (spousal support) received from any prior

marriage/relationship �

� � � Rental payments received (from property you rent to others) �� Bonuses received �� Other sources of income received: (please specify) ��

Total Gross Income (add lines 1-12) MONTHLY DEDUCTIONS14. Number of tax exemptions claimed �

15. Monthly federal income tax withheld 16. Monthly state income tax withheld �17. Social Security 18. Medicare �19. Medical insurance �20. Other insurances �21. Union or other dues �22. Retirement or pension fund �23. Savings plan �24. Credit union �25. Child support or spousal support payments �26. Other deductions: (please specify) �27. �28. Total Monthly Deductions (add lines 14 – 27) �

MONTHLY NET INCOME (subtract line 28 from line 13)

$3,107.39$0.00$0.00$0.00$0.00$0.00

$0.00$0.00$0.00

$4,309.38

$685.58$259.05$281.24$65.78$0.00$0.00$0.00$2,800.00$0.00

$0.00

$4,091.65

$217.73

SAMPLE



Page 3 of 8

5. ANTICIPATED MONTHLY EXPENSES

My Monthly Expenses �1. Rent or mortgage payment (primary residence) �2. Real Estate Property taxes (residence) �3. Repairs and maintenance (including maintenance of appliances and furnishings) �4. Food (include eating out) and household supplies �5. Utilities (electricity, heat, water, sewage, trash) �6. Telephone (local, long distance & cellular) �7. Cable and Internet Services �8. Laundry and dry cleaning �9. Clothing and shoes �10. Medical, dental and prescription drug expenses (not covered by insurance) �11. Insurance (life, health, accident, auto, liability, disability, homeowner’s or renter’s-

excluding insurance that is paid through payroll deductions) �

�

12. Childcare (babysitting and day care) �13. Child support or spousal support payments (due to previous marriage or relationship)

(Exclude payments made through payroll deductions) �

�

14. School expenses (child and adult education) �15. Entertainment (include clubs, social obligations, travel, recreation) �16. Incidentals (grooming, tobacco, alcohol, gifts, holidays and special occasions) �17. Transportation (other than automobile) �18. Auto payments (loans/leases) �19. Auto expenses (gas, oil, repairs, maintenance) �20. Newspapers, magazines, books �21. Care and maintenance of pets (food, vet, grooming) �22. Payments to any dependents not living in your home and not included in a category

above (including college age children) �

�

23. Hobbies �24. Other taxes than those listed above (exclude payroll deductions) �25. Other expenses (include expenses of other real properties owned, professional

services such as counseling and tax/legal advice, etc) �

�

Other Monthly installment payments: �26. Mortgage (other than primary mortgage) �27. Other vehicle payments �28. Credit card debt (total minimum monthly payments) �29. Court ordered obligations �30. Student loans �31. Personal loans � � TOTAL MONTHLY EXPENSES (Add lines 1-31) �

�

�

�

�

$0.00$888.00

$0.00

$200.00

$208.00

$0.00$0.00

$0.00$0.00

$0.00

$15.00

$0.00

$0.00

$0.00$0.00$0.00

$0.00$0.00

$0.00$0.00

$0.00

$0.00

$0.00

$1,311.00

SAMPLE



Page 4 of 8

�

6. ASSETS: List ALL assets that you own individually and together with your spouse without regard to how they have been or will be divided later.

If you do not have assets in an asset category, write “none” under the heading and enter “zero” in the estimated value column. If you need more space, please attach additional sheets.

W = Wife H=Husband

B=Both

Ownership or Title Held by

Current Possession

Household Items W H B W H B

Amount Owed Estimated

Value Today

Household furniture & accessories

Household appliances

Kitchen equipment

China, silver, crystal

Jewelry

Clothing

Antiques

Art

Electronic equipment

Sports equipment

Recreational vehicles, boats

Tools

Other

Automobiles: Year, Make, Model

Amount Owed

Estimated Value Today

SAMPLE



Page 5 of 8

Ownership or Title held by W = Wife H=Husband B=Both


Name of Company & # of shares W H B

Value Today

Life Insurance Name of Company & Policy #

Beneficiary Face Amount Cash Value

Today ��

� � �

�

� � �

��

� � �

��

� � �

Cash and Deposit (Savings and Checking) Accounts

Name of Bank or Financial Institution

Type of Account

Account # Last 4 digits

Balance Today

Pension, Retirement Accounts, Deferred Compensation, 401K

Plans, IRAs, Profit Sharing, etc. Name of Company & Type of Plan

% Vested if known

Date of Valuation Value Today

SAMPLE



Page 6 of 8

Business Interests Name of Business & Address

W H B Type of

Business % of Ownership

Value MINUS Indebtedness

Other Personal Property Description of Asset

Type of Property

Value

Ownership Acquired by Date Acquired Value Today Assets Acquired

Description of Asset G - Gift

I - Inherited B - Before Marriage

W H B G I B

Real Estate Parcel 1 Parcel 2 Parcel 3

Type of Property

Address: street, city, state

Current Fair Market Value

Current Mortgage Balance

Other Liens

SAMPLE



Page 7 of 8

7. MEDICAL, HOMEOWNERS/RENTERS, AUTOMOBILE, OTHER INSURANCE

What type of insurance policies do you have?

Name of Company, Group # & Policy # W H B

Type of Insurance

Date Issued

��

�

8. DEBTS: List ALL debts that you owe individually and together with your spouse without regard to who will

be responsible for payment later.

If there are additional DEBTS, please attach a separate sheet of paper with the creditor’s name and address, the type of obligation, who pays (W, H, B) and the current balance.

Who Currently Pays Creditor’s Name & Address

Type of Obligation

W H B

Monthly Payment

Current Balance

XYZ Health Plan, policy number ending in 5555 ✔ Medical

✔USA Inc. 7,500.00397.03Auto Loan

SAMPLE



Page 8 of 8

�

�

9. DISPOSAL OF ASSETS Did you dispose of any assets (sold, given away, or destroyed) in the 12 months before the case was filed?

Yes No If yes, complete chart below:

�� "! �� # $%��! �'& � ��(� ��*) ��#,+ ��-�� "! �� #

� � �

� � �

� � �

� � �

10. CURRENT LITIGATION

Are you a party in any other lawsuit or litigation? Yes No If yes, identify the lawsuit or litigation.

11. BANKRUPTCY

Have you ever filed for bankruptcy? Yes No If yes , identify the following: Type of filing Date of filing Current status

12. DECLARATION

I declare under the penalty of perjury that the above, including all attachments, is true and correct as of the date signed below.


Signature

Print or Type Name

Date

Jane DoeSAMPLE

PRINT in INK

FA-4161V, 02/10 Findings of Fact, Conclusions of Law, and Judgment-Without Minor Children §767.251, Wisconsin Statutes




is filed.


COUNTY

For Official Use


petitioner. If joint


of the wife.

In RE: The marriage of

Petitioner/Joint Petitioner-Wife:


and

Findings of Fact,

Conclusions of Law, and Judgment

Without Minor Children

Divorce-40101

Legal Separation-40201

Case No.


respondent. If joint


of the husband.

Respondent/Joint Petitioner-Husband:


Check divorce or legal

separation.


FINAL HEARING A final hearing was conducted in this matter as follows:

1. Before

Circuit Court Judge Circuit Court Commissioner

2. Location

3. Date

APPEARANCES 1. Wife

appeared in person appeared by phone did not appear AND

a. was self-represented.

b. was represented by Attorney .

2. Husband

appeared in person appeared by phone did not appear AND

a. was self-represented.

b. was represented by Attorney .

3. Others appearing at the hearing

a. None.

b. Other: .

In 1, enter the name of

the court official who

granted the judgment and

the address and date

[month, day, year] on

which it was granted.

In 1, check how the party

appeared.

If b, enter the name of

the attorney.

In 3, check a, or b.


the individual(s) who

appeared.

In 2, check how the party

appeared.


the attorney.

PORTAGE

Jane Doe

John Doe

✔

✔

✔

✔

✔

SAMPLE

Findings of Fact, Conclusions of Law, and Judgment-Without Minor Children Page 2 of 5 Case No. _______________

FA-4161V, 02/10 Findings of Fact, Conclusions of Law, and Judgment-Without Minor Children §767.251, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

Page 2 of 5

FINDINGS OF FACT

A. Jurisdiction 1. All necessary parties were properly served and 120 days have lapsed since the

filing of the joint petition or the date of service of the summons and petition, whichever

applies.

2. At the time of the final hearing, the parties requested a:

a. Divorce: The court finds the marriage is irretrievably broken. b. Legal Separation: The court finds the marital relationship is broken and

acceptable reasons have been given to the court for the request.

3. All jurisdictional requirements for a judgment have been met.

B. Parties (as of the date of the final hearing)

1. The wife in this action is:

Name

Address

Address

City State Zip

Date of birth

Gross monthly income $

2. The husband in this action is:

Name

Address

Address

City State Zip

Date of birth

Gross monthly income $

C. Children

1. a. No children were born to or adopted together by the parties before or during the

marriage.

b. All children born to the wife or adopted together by the parties before or during the

marriage are as set forth in the petition.

2. The wife

a. is not currently pregnant.

b. is currently pregnant and

1. the husband is found to be the father. STOP! You must use FA-4160

instead of this form.

2. the husband is not found to be the father and the marital presumption in

§891.41(2), Wis. Stats. has been rebutted.

A. A paternity case is not pending. B. A paternity case is pending in county in the state

of with case number .

3. The parties’ assets, their interests, values, and their encumbrances and debts are found

to be as stated in the Financial Disclosure Statements, which were updated as required

by statute on the record at the time of trial and are on file.

In c, check a or b.

In 2, check a or b.

In B.1, enter the

requested information

about the wife. If you do

not know an answer,

enter “unknown” in the

blank.

In 2, enter the requested

information about the

husband. If you do not

know an answer, enter

“unknown” in the blank.

In 2, check a or b.

If b, check 1 or 2.

If 2, check A or B.

If B, enter the name of the

county and state in which

the case is pending and

write the case number

assigned to it.

✔

John Doe

Jane Doe

123 Main Street


123 Main Street


July 20, 1978

June 25, 1977

3,107.39

4,309.38

✔

✔SAMPLE



Page 3 of 5

4. A Marital Settlement Agreement or Proposed Marital Settlement has been submitted.

The party(s) have asked that it be approved by the Court. All parties present have been

informed of the legal consequences if the Court approves the document in whole or in

part.

D. Past Due Maintenance

The amount of the past due arrearages for maintenance at the time of the final hearing is

1. none (zero).

2. as agreed in the Marital Settlement Agreement or Proposed Marital Settlement.

3. $ which shall earn interest at the rate of % per year and shall be paid as

a. a one-time payment to the WI SCTF made by (Date) .

b. through monthly income withholding by the WI SCTF in the amount of $

beginning , 20 until the arrearages are

paid in full.

CONCLUSIONS OF LAW AND JUDGMENT

A. The Court grants a judgment of

1. Divorce. The marriage between the parties is dissolved and the parties are divorced

effective on date of hearing. other date:

The parties are informed by the court that under §765.03(2), Wis. Stats.

It is unlawful for any person who is or has been a party to an action of divorce in

any court in this state, or elsewhere, to marry again until six months after judgment

of divorce is granted, and the marriage of any such person solemnized before the

expiration of six months from the date of the granting of judgment of divorce shall

be void.

2. Legal Separation. The marital relationship is broken and the parties are granted a

judgment of legal separation effective on date of hearing. other date:

The parties are informed by the court that under §767.35, Wis. Stats.:

In case of reconciliation, at any time, the parties may apply for a revocation of

the judgment of legal separation.

The court shall convert the decree to a decree of divorce:

by stipulation of both parties at any time, OR

upon motion of either party not earlier than one year after entry of a decree

of legal separation.

B. Final Orders

1. The Marital Settlement Agreement dated or

Proposed Marital Settlement dated of the

wife husband is approved, attached and made the judgment of the court except as

changed below:

2. No Marital Settlement Agreement or Proposed Marital Settlement was approved by

the court. A Divorce Judgment Addendum has been prepared to reflect the Judges’

orders, is attached and is made the judgment of the court.

C. Lis Pendens

Any Lis Pendens filed in this action is released.

In A, check 1 or 2 and

enter the effective date.

In D, check 1, 2 or 3.

If 3, enter the amount

and interest rate and

check a or b. If a, enter

the date. If b, enter

payment amount, and the

date payments begin.

In B.1, check the

appropriate boxes and

enter the date [month,

day, year] that the

party(s) signed the

checked document and

attach the document.

If the court made

changes, write them in

the space provided.

If 1 does not apply,

check 2.

✔

✔

✔SAMPLE



Page 4 of 5

D. Legal Name Restoration 1. Neither party is awarded the right to use a former legal surname.

2. The wife is awarded the right to use a former legal surname of .

3. The husband is awarded the right to use a former legal surname of .

Note: If this is an action for legal separation, the court cannot allow a spouse to resume a former legal

surname unless and until the judgment is converted to a divorce.

E. Maintenance 1. Pursuant to §767.75, Wis. Stats., this judgment constitutes an immediate assignment of all

commissions, earnings, salaries, wages, pension benefits, benefits under Chapter 102 or 108, and other money due or to be due in the future, to the WI SCTF. The assignment shall be for an amount sufficient to ensure payment under this judgment, so long as the addition of the amount toward arrears does not leave the party at an income below the poverty line established under 42 USC 9902(2).

2. Pursuant to §767.57(1)(a), Wis. Stats., all payments for maintenance ordered shall note

the case number and the names of the parties on the face of the check, should be made payable to WI SCTF, and sent to:

Wisconsin Support Collections Trust Fund Box 74200 Milwaukee, WI 53274-0200

The WI SCTF will transmit the payments to the proper persons entitled to them.

Failure of an employer to pay the proper amount shall not be a defense for failure to pay the

proper amount. If an employer fails to take out the correct amount for maintenance, the party

paying is responsible for paying the full and correct amount directly to WI SCTF.

Pursuant to §767.57(1e), Wis. Stats., the party making payment for maintenance is responsible for payment of the annual receiving and disbursing fee to WI SCTF.

3. If maintenance is not denied, both parties shall notify, in writing, the other party and the

Clerk of Court and the Child Support Agency of the county in which this action is filed, within 10 business days, of any change of employer and employer’s address.

4. Pursuant to §767.75, Wis. Stats., a withholding assignment or order under this section has

priority over any other assignment, garnishment, or similar legal process under Wisconsin law. The employer shall not withhold more of the employee’s disposable income than allowed pursuant to the Federal Consumer Credit Protection Act unless the employee agrees to have the full amount withheld. No employer may use an assignment under this section to deny employment, or to discharge or take disciplinary action against an employee.

F. Property Division

Notice is given of the provisions of §767.61 (5) (a) and (b) and §767.61(6), Wis. Stats.

The parties shall transfer title to property of the parties as necessary, in accordance with the

division of property set forth in the judgment. The parties are notified that

1. it may be necessary for the parties to take additional actions in order to transfer interests in their property in accordance with the division of property set forth in the judgment, including such interests as interests in real property, interests in retirement benefits, and contractual interests.

2. the judgment does not necessarily affect the ability of a creditor to proceed against a

party or against that party's property even though the party is not responsible for the debt under the terms of the judgment.

In D, check 1, 2, or 3.

If 2 or 3, enter the

former legal surname.

✔

✔

Eod

SAMPLE



Page 5 of 5

3. an instrument executed by a party before the judgment naming the other party as a beneficiary is not necessarily affected by the judgment and it may be necessary to revise the instrument if a change in beneficiary is desired.

4. a deed consistent with the judgment or a certified copy of the portion of the judgment

affecting title to real property shall be recorded in the office of the register of deeds of the county in which the real property is located.

G. Court Ordered Fees

All payments of attorney fees shall be paid directly to the attorney or to the agency providing

services which may enforce the order in its name.

H. Restraining Order

Both parties are restrained from interfering with the personal liberty of the other.

I. Non-Compliance

Disobedience of the court orders is punishable under ch. 785 Wis. Stats. by commitment to

the county jail until the judgment is complied with and the costs and expense of the

proceedings are paid or until the party committed is otherwise discharged, according to law.

J. Entry of Judgment

The Clerk of Court’s office, per §806.06(1)(2), Wis. Stats., shall enter this judgment by affixing

a file stamp that is dated.

THIS IS A FINAL ORDER FOR PURPOSES OF APPEAL IF SIGNED BY A CIRCUIT COURT JUDGE.

BY THE COURT:

For Court Use Only.

Circuit Court Judge Circuit Court Commissioner

Print or Type Name

Date

APPROVED AS TO FORM BY:

Petitioner/ Joint Petitioner-Wife Respondent/Joint Petitioner-Husband

All parties to the action

should approve how

accurately the form was

completed before the

judge signs it. The parties

must approve by signing

in the space to the right.

SAMPLE

joint petition

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