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Volunteer First Name: _____________________________ Date: _________________ MILWAUKEE JUSTICE CENTER JOINT,STIPULATED,DEFAULT DIVORCE “PART 2” CASE SUMMARY In re: the marriage of Case # ____ FA ____________ _____________________________________ Petitioner/Jt. Petitioner Wife and _____________________________________ Family A B C D E Respondent/ Jt. Petitioner Husband 1. This case was filed with the Clerk of Circuit Court on _____________________, 20_____. 2. [ ] The summons and petition were personally served on the respondent on_______________, 20____, which is within 90 days of the filing date; 120 days from that date of service is ___________ , 20 ____. OR [ ] The time for service of the summons and petition was extended to __________________, 20____. The summons and petition were served on the Respondent on ___________________, 20_____; 120 days from that date of service is _______________________, 20______. OR [ ] Despite due diligence, respondent could not be personally served. Service was accomplished by publication and mailing as required by Sec. 801.11(1)(c); the last date of publication was ___________________ , 20 ______ ; 120 days from the first date of publication is__________________ , 20______. Affidavit of Nonservice [ ] is attached OR [ ] was previously filed. Proof of publication [ ] is attached OR [ ] was previously filed. [ ] This case was filed as a joint petition; 120 days from the filing date is _________________, 20____. 3. [ ] This case involves minor children, the [husband] [wife] [both parties] have met the requirement to attend a parent education program and there is a report acknowledging this on file with the Court. OR [ ] The parties presently have no minor children; there is no parent education requirement in this case. OR [ ] The parental education requirement has been waived for [husband] [wife] [both parties]. A copy of the waiver order: [ ] is attached [ ]was previously filed with the court. 4. [ ] A proposed parenting plan is attached. I CERTIFY THAT THIS INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE Signature:________________________________________________Date:________________________ Name printed/typed:_____________________________ Daytime phone number: (___ )_____________

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Page 1: MILWAUKEE JUSTICE CENTER JOINT STIPULATED … · debts that you owe individually and together with the other party without regard to who will be responsible for payment later. If

Volunteer First Name: _____________________________ Date: _________________

MILWAUKEE JUSTICE CENTER

JOINT,  STIPULATED,  DEFAULT  DIVORCE  “PART  2”    CASE  SUMMARY  

 

In  re:  the  marriage  of               Case  #    ____    FA  ____________  _____________________________________                                                              Petitioner/Jt.  Petitioner  Wife  -­‐‑-­‐‑-­‐‑and-­‐‑-­‐‑-­‐‑  _____________________________________       Family        A            B            C            D            E                                    Respondent/  Jt.  Petitioner  Husband      

1. This  case  was  filed  with  the  Clerk  of  Circuit  Court  on  _____________________,  20_____.    

2. [        ]  The  summons  and  petition  were  personally  served  on  the  respondent  on_______________,  20____,                      which  is  within  90  days  of  the  filing  date;  120  days  from  that  date  of  service  is  ___________  ,  20  ____.  OR    

[        ]    The  time  for  service  of  the  summons  and  petition  was  extended  to  __________________,  20____.                        The  summons  and  petition  were  served  on  the  Respondent  on  ___________________,  20_____;                        120  days  from  that  date  of  service  is  _______________________,  20______.  OR    

[        ]    Despite  due  diligence,  respondent  could  not  be  personally  served.  Service  was                        accomplished  by  publication  and  mailing  as  required  by  Sec.  801.11(1)(c);  the  last  date  of                      publication  was  ___________________  ,  20  ______  ;  120  days  from  the  first  date  of                      publication  is__________________  ,  20______.  

Affidavit  of  Non-­‐‑service  [      ]  is  attached  OR    [      ]  was  previously  filed.  Proof  of  publication  [      ]  is  attached  OR    [      ]  was  previously  filed.  

 [        ]    This  case  was  filed  as  a  joint  petition;    120  days  from  the  filing  date  is  _________________,  20____.    

 

3. [      ]      This  case  involves  minor  children,  the  [husband]  [wife]  [both  parties]  have  met  the  requirement  to                        attend  a  parent  education  program  and  there  is  a  report  acknowledging  this  on  file  with  the  Court.  OR    

[        ]  The  parties  presently  have  no  minor  children;    there  is  no  parent  education  requirement  in  this  case.  OR    

[        ]  The  parental  education  requirement  has  been  waived  for  [husband]  [wife]  [both  parties].         A  copy  of  the  waiver  order:  [      ]  is  attached  [        ]was  previously  filed  with  the  court.  

 

4. [      ]    A  proposed  parenting  plan  is  attached.      I  CERTIFY  THAT  THIS  INFORMATION  IS  CORRECT  TO  THE  BEST  OF  MY  KNOWLEDGE  Signature:________________________________________________Date:________________________  Name  printed/typed:_____________________________  Daytime  phone  number:  (___  )_____________  

Page 2: MILWAUKEE JUSTICE CENTER JOINT STIPULATED … · debts that you owe individually and together with the other party without regard to who will be responsible for payment later. If

Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B:

FA-4139V, 05/17 Financial Disclosure Statement §767.127, Wisconsin StatutesThis form shall not be modified. It may be supplemented with additional material.

Page 1 of 8

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

STATE OF WISCONSIN, CIRCUIT COURT, COUNTY

Enter the name of the Petitioner/Joint Petitioner A.

IN RE: THE MARRIAGE OF Petitioner/Joint Petitioner A

Name (First, Middle and Last)

and

On the far right, check Petitioner/Joint Petitioner A or Respondent/Joint Petitioner B. Financial Disclosure

Statement of Petitioner/Joint Petitioner A Respondent/Joint Petitioner B

Case No.

Enter the name of the Respondent/Joint Petitioner B.

Respondent/Joint Petitioner B

Name (First, Middle and Last) Enter the case number.

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 Petition on the Respondent/Joint Petitioner B or the filing of a Joint Petition. 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. Deliberate failure 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 INFORMATIONNameAddressAddressCity 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

Page 3: MILWAUKEE JUSTICE CENTER JOINT STIPULATED … · debts that you owe individually and together with the other party without regard to who will be responsible for payment later. If

Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: Financial Disclosure Statement Page 2 of 8 Case No.

FA-4139V, 05/17 Financial Disclosure Statement §767.127, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

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.

I live alone. Name Relationship This person helps pay expenses

Yes No 1. 2. 3. 4. 5. 6. 7. 8.

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 4.33 every other week (bi-weekly) multiply bi-weekly income by 2.17 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.)

2. Pensions and retirement funds received 3. Social Security benefits received 4. Disability and Unemployment Insurance received 5. Public Assistance Funds received 6. Interest and Dividends received 7. Child Support and maintenance (spousal support) received from any prior

marriage/relationship

8. Rental payments received (from property you rent to others) 9. Bonuses received 10. Other sources of income received: (please specify) 11. 12. 13. Total Gross Income (add lines 1-12) MONTHLY DEDUCTIONS 14. 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)

Page 4: MILWAUKEE JUSTICE CENTER JOINT STIPULATED … · debts that you owe individually and together with the other party without regard to who will be responsible for payment later. If

Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: Financial Disclosure Statement Page 3 of 8 Case No.

FA-4139V, 05/17 Financial Disclosure Statement §767.127, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

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)

Page 5: MILWAUKEE JUSTICE CENTER JOINT STIPULATED … · debts that you owe individually and together with the other party without regard to who will be responsible for payment later. If

Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: Financial Disclosure Statement Page 4 of 8 Case No.

FA-4139V, 05/17 Financial Disclosure Statement §767.127, Wisconsin StatutesThis form shall not be modified. It may be supplemented with additional material.

Page 4 of 8

6. ASSETS: List ALL assets that you own individually and together with the other party without regard to howthey 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 valuecolumn. If you need more space, please attach additional sheets.

A = Joint Petitioner A B = Joint Petitioner B T = Together

Ownership or Title Held by

Current Possession Estimated

Value Today Household Items A B T A B T Amount Owed Household furniture & accessories

Household appliances

Kitchen equipment

China, silver, crystal

Jewelry

Clothing

Antiques

Art

Electronic equipment

Sports equipment

Recreational vehicles, boats

Tools

Other

Other

Automobiles: Year, Make, Model A B T A B T Amount Owed Estimated

Value Today

Page 6: MILWAUKEE JUSTICE CENTER JOINT STIPULATED … · debts that you owe individually and together with the other party without regard to who will be responsible for payment later. If

Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: Financial Disclosure Statement Page 5 of 8 Case No.

FA-4139V, 05/17 Financial Disclosure Statement §767.127, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

Page 5 of 8

Life Insurance Name of Company & Policy # A B T Beneficiary Face Amount Cash Value

Today

Business Interests

Name of Business & Address A B T Type of Business % of Ownership Value MINUS Indebtedness

Securities: Stocks, Bonds, Mutual Funds, Commodity Accounts

Name of Company & # of shares

Ownership or Title held by A = Joint Petitioner A B = Joint Petitioner B T = Together

Value Today

A B T

Pension, Retirement Accounts, Deferred Compensation, 401K

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

% Vested if known Date of Valuation Value

Today

Page 7: MILWAUKEE JUSTICE CENTER JOINT STIPULATED … · debts that you owe individually and together with the other party without regard to who will be responsible for payment later. If

Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: Financial Disclosure Statement Page 6 of 8 Case No.

FA-4139V, 05/17 Financial Disclosure Statement §767.127, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

Page 6 of 8

Cash and Deposit Accounts (Savings and Checking)

Name of Bank or Financial Institution A B T

Type of Account

Account # Last 4 digits

Balance Today

Other Personal Property

Description of Asset A B T Type of Property

Value

Assets Acquired Description of Asset

Ownership Acquired by

Date Acquired Value Today

A = Joint Petitioner A B = Joint Petitioner B T = Together

G - Gift I - Inherited B - Before Marriage

A B T G I B

Real Estate Parcel 1 Parcel 2 Parcel 3

Type of Property

Address: Street, City, State

Ownership/Title A B T A B T A B T

Current Fair Market Value

Current Mortgage Balance

Page 8: MILWAUKEE JUSTICE CENTER JOINT STIPULATED … · debts that you owe individually and together with the other party without regard to who will be responsible for payment later. If

Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: Financial Disclosure Statement Page 7 of 8 Case No.

FA-4139V, 05/17 Financial Disclosure Statement §767.127, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

Page 7 of 8

Other Liens

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

What type of insurance policies do you have?

Name of Company, Group # & Policy # A B T Type of Insurance Date Issued

8. DEBTS: List ALL debts that you owe individually and together with the other party 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 (A, B, T) and the current balance.

Creditor’s Name & Address Type of Obligation

Who Currently Pays Monthly Payment

Current Balance A B T

Page 9: MILWAUKEE JUSTICE CENTER JOINT STIPULATED … · debts that you owe individually and together with the other party without regard to who will be responsible for payment later. If

Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: Financial Disclosure Statement Page 8 of 8 Case No.

FA-4139V, 05/17 Financial Disclosure Statement §767.127, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

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:

Property / Asset Date of Disposal Fair Market Value on Date of Disposal

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, are complete, true, and correct.

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 Ty pe Name

Date

Page 10: MILWAUKEE JUSTICE CENTER JOINT STIPULATED … · debts that you owe individually and together with the other party without regard to who will be responsible for payment later. If

Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B:

FA-4153V, 05/17 Proposed Marital Settlement Order Without Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

Page 1 of 7

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

STATE OF WISCONSIN, CIRCUIT COURT, COUNTY

Enter the name of the Petitioner/Joint Petitioner A.

IN RE: THE MARRIAGE OF Petitioner/Joint Petitioner A Name (First, Middle and Last)

and

Proposed Marital Settlement

Without Minor Children

Divorce-40101 Legal Separation-40201

Case No.

Enter the name of the Respondent/Joint Petitioner B.

Respondent/Joint Petitioner B Name (First, Middle and Last)

Check divorce or legal separation. Enter the case number.

Warning: Subject to court approval, the terms of this proposal may be included in your judgment of divorce or legal

separation. Be sure you understand it completely. Some portions of this proposal 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 proposal to be sure you are fully aware of the laws that may apply to you.

I REQUEST THAT THE COURT GRANT THE FOLLOWING: In A, check 1 or 2. If 2, enter the reason you are asking for a legal separation and not a divorce.

A. MARITAL RELATIONSHIP 1. Divorce. This marriage is irretrievably broken. 2. Legal Separation. This marriage is broken and the reason I am requesting a legal

separation and not a divorce is . In B1, check a, b, or c. If b, enter a date and choose 1 or 2.

B. MAINTENANCE (Spousal Support) 1. Petitioner/Joint Petitioner A a. gives up right to receive maintenance and understands that by giving up maintenance

at this time, may never ask for maintenance. b. is not requesting maintenance at this time, but leaves open the right to request it until

. The right to request maintenance is limited to If 1, enter the reasons. 1) the following circumstance(s) only:

2) any appropriate substantial change in circumstance. If c, enter the maintenance amount and the date the payments should begin and end.

c.

Respondent/Joint Petitioner B shall pay maintenance to Petitioner/Joint Petitioner A in the amount of $ per month beginning , 20 . Maintenance shall end , 20 , or until Petitioner/Joint Petitioner A remarries, dies, or by court order, whichever comes first.

2. Respondent/Joint Petitioner B In 2, check a, b, or c. If b, enter a date and choose 1 or 2.

a. gives up right to receive maintenance and understands that by giving up maintenance at this time, may never ask for maintenance.

b. is not requesting maintenance at this time, but leaves open the right to request it until . The right to request maintenance is limited to

If 1, enter the reasons. 1) the following circumstance(s) only: 2) any appropriate substantial change in circumstance. If c, enter the maintenance amount and the date the payments should begin and end.

c. Petitioner/Joint Petitioner A shall pay maintenance to Respondent/Joint Petitioner B in the amount of $ per month beginning , 20 . Maintenance shall end 20 , or until Respondent/Joint Petitioner B remarries, dies, or by court order, whichever comes first.

In 3, check a or b. 3. Payments shall be made a. no payments are ordered. If b, check 1 or 2. If 2, enter the employer information.

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).

Page 11: MILWAUKEE JUSTICE CENTER JOINT STIPULATED … · debts that you owe individually and together with the other party without regard to who will be responsible for payment later. If

Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: Proposed Marital Settlement without Minor Children Page 2 of 7 Case No.

FA-4153V, 05/17 Proposed Marital Settlement Order Without Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

Page 2 of 7

2) by income assignment from the payer’s employer as indicated below: Employer name

Address of payroll office City State Zip Phone Fax

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, the 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 on which the payments shall begin and the percentage rate for arrearages.

4. Arrearages for Previously Ordered Maintenance. The maintenance arrears shall be handled 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] , 20 . 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. In D, complete this section with as much detail as possible.

D. PERSONAL PROPERTY DIVISION 1. Division. I propose the final personal property division as indicated below: List the property and check who

will have permanent use of the property once the divorce/legal separation is final.

Who will have possession? A = Petitioner/Joint Petitioner A B = Respondent/Joint Petitioner B

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.

HOUSEHOLD ITEMS A B AUTOMOBILES

Year, Make, Model A B

NOTE: If you have already divided the property, you must still disclose how you divided it.

LIFE INSURANCE

Name of Company & Policy # A B

NOTE: Any and all assets disclosed on the parties’ Financial Disclosure Statements should be included here and divided between the parties.

BUSINESS INTERESTS

Name of Business & Address A B

SECURITIES: STOCKS, BONDS, MUTUAL FUNDS, COMMODITY ACCOUNTS

Name of Company & # of shares A B

Page 12: MILWAUKEE JUSTICE CENTER JOINT STIPULATED … · debts that you owe individually and together with the other party without regard to who will be responsible for payment later. If

Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: Proposed Marital Settlement without Minor Children Page 3 of 7 Case No.

FA-4153V, 05/17 Proposed Marital Settlement Order Without Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

Page 3 of 7

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.

PENSION, RETIREMENT ACCOUNTS,

DEFERRED COMPENSATION, 401K PLANS, IRAS, PROFIT SHARING, ETC. Name of Company & Type of Plan

A B

CASH AND DEPOSIT (SAVINGS & CHECKING) ACCOUNTS

Name of Bank or Financial Institution A B

OTHER PERSONAL PROPERTY

Description of Asset A B

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. In 2, check a or b. If b, list the items and indicate when and how any exchange of personal property will take place.

b. List of items: The exchange of personal property shall be made by [Date] , 20 according to the following arrangements: Any item of personal property not listed above shall be awarded to the party who has possession at the time of the final hearing.

In E, check 1 or 2. E. DIVISION OF REAL ESTATE If 2, if 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.

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)

Attach a copy of the legal description.

Attached is a legal description of this property. Check 1 or 2. 1) This primary residence shall be awarded to the If 1, check A or B and enter other provisions, if any.

A. Petitioner/Joint Petitioner A B. Respondent/Joint Petitioner B 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 If 2, check 1, 2, 3, or 4 in A, B, and C for the responsibility for other expenditures that occur

2) This residence shall be placed on the market for sale. A. Pending sale, the residence shall be occupied, used, or managed by 1. Petitioner/Joint Petitioner A. 2. Respondent/Joint Petitioner B.

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Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: Proposed Marital Settlement without Minor Children Page 4 of 7 Case No.

FA-4153V, 05/17 Proposed Marital Settlement Order Without Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

Page 4 of 7

while the property is being sold.

3. shared equally. 4. Other: B. Pending sale, the mortgage, taxes, and insurance shall be paid by 1. Petitioner/Joint Petitioner A. 2. Respondent/Joint Petitioner B. 3. shared equally. 4. Other:

C. Pending sale, any necessary repairs, special assessments and other sale-related expenses shall be paid by

1. Petitioner/Joint Petitioner A. 2. Respondent/Joint Petitioner B. 3. shared equally. 4. Other: Enter the percentage each party shall receive in a and b. The total amount must equal 100 %.

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:

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.

a. Petitioner/Joint Petitioner A to receive %. b. Respondent/Joint Petitioner B to receive %. 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. This proposed marital settlement 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.

In F, for each debt owed individually and jointly, write the name, current balance, and check who will be responsible for payment.

F. 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 I propose shall be responsible for the payment of each debt:

Payment for Payment to (Creditor)

Balance Due

Paid by Petitioner/

Joint Petitioner A

Paid by Respondent/

Joint Petitioner B

Shared Equally

Mortgage/Rent $ 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.

Mortgage/Rent $ 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 The parties 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.

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Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: Proposed Marital Settlement without Minor Children Page 5 of 7 Case No.

FA-4153V, 05/17 Proposed Marital Settlement Order Without Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

Page 5 of 7

• Any debt not listed shall be the responsibility of the party who incurred the debt. • Creditors are NOT bound by this proposal and both parties remain 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. In G, check 1 or 2. G. EQUALIZATION OF MARITAL PROPERTY DIVISION If 1, check a or b. 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. If 2, enter the amount and in a, check 1 or 2.

2. A payment of $ is required to equalize the marital property division. a. This payment shall be made by the

1) Petitioner/Joint Petitioner A to Respondent/Joint Petitioner B. 2) Respondent/Joint Petitioner B to Petitioner/Joint Petitioner A. In b, check 1, 2 or 3. If 2, enter the date [month, day, year]. If 3, enter the amount, date and percentage and check A or B.

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 [Date] ,

20 , until paid in full. 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 shall 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 are responsible for seeking tax advice from a tax professional with regard to issues of this divorce/legal separation.

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

2. Years Before Divorce/Legal Separation a. Tax returns for all previous years were filed. b. The parties shall file returns for the previous tax years as follows: 1) share preparation expenses, tax liability and/or refund equally. 2) Other:

In I, check 1, 2, or 3. I. LEGAL NAME RESTORATION I propose that 1. neither party have the right to use a former legal surname. If 2 or 3, enter the former legal surname.

2. Petitioner/Joint Petitioner A to have the right to use a former legal surname of . 3. Respondent/Joint Petitioner B to have the right to use a former legal surname of .

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

In J, check 1 or 2. J. OTHER PROPOSALS I understand that any oral agreements are not enforceable by the court. If 2, attach any additional agreements.

1. I have no other proposals, written or oral, concerning this marriage. 2. I have additional written proposals concerning this marriage, copies of which are attached.

K. UNDERSTANDINGS I understand: • I could get an attorney to review this proposal.

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Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: Proposed Marital Settlement without Minor Children Page 6 of 7 Case No.

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Page 6 of 7

• This form was provided as a convenience and may NOT cover all issues. • This proposal may have tax consequences and that seeking tax advice is suggested. • I have fully disclosed my 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 PROPOSAL I assume responsibility for the entire content of this proposal. I have made this proposal freely

and voluntarily and not because of any undue influence. I believe the terms to be fair and reasonable under the circumstances. I acknowledge that there may be substantial legal and tax implications with regard to this proposal. I understand that lack of knowledge of the law may not be sufficient to convince the court that relief from these provisions is required. I acknowledge that I have the right to seek the advice of my own personal attorney.

M. GENERAL RELEASE The parties are released from any claim of any nature that may exist. Neither party may, at any

time, sue the other, personal representatives, and assigns, for the purpose of enforcing any nor all of the rights relinquished and/or waived under this proposal. 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. I understand that this general release shall not become effective until this Proposed Marital Settlement is approved by the court.

N. FULL DISCLOSURE AND RELIANCE I warrant that I have provided an accurate, complete, and current disclosure of all income, assets,

debts, and liabilities. I understand that deliberate failure to provide complete disclosure constitutes perjury under §767.127, Wis. Stats., and a fraud upon the court. The property referred to in this proposal represents all the property in which either party has any interest. This proposal is based on my financial disclosure statement.

O. RESTRAINING ORDER Neither party may 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, the parties shall execute and deliver any and all documents that

may be necessary to carry out the terms and conditions of this proposal. Q. DIVESTING OF PROPERTY RIGHTS The parties give up all rights to the property awarded to the other, except as otherwise provided

for in this proposal. All property awarded to a party shall be the separate property of that party. The parties shall have the right to manage our separate property as if they had never been married.

R. SURVIVAL OF PROPOSAL AFTER JUDGMENT The provisions of this proposal shall survive any subsequent judgment of divorce and shall have

independent legal significance. This proposal is a legally binding contract, entered into for good and valuable consideration. It is contemplated that in the future either party may enforce this proposal 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 I submit this proposal to the court for approval and request the court to incorporate its terms in the

final judgment. Once approved by the court, I understand that either of us may enforce this

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Page 7 of 7

proposal in this or any other court of competent jurisdiction. U. WAIVER OF APPEARANCE 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 Proposed Marital Settlement even if the respondent or one of the joint petitioners does not appear.

The party who is proposing the above agreements must sign and enter the date on which it was signed. NOTE: This signature does not need to be notarized.

Petitioner/Joint Petitioner A Respondent/Joint Petitioner B

Print or Type Name

Date

If the other party does later agree with your proposal, you may have them sign and print their name. NOTE: This signature does not need to be notarized.

Petitioner/Joint Petitioner A Respondent/Joint Petitioner B

Print or Type Name

Date

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Petitioner/Joint Petitioner A: Case No. Respondent/Joint Petitioner B:

FA-4153V, 05/17 Proposed Marital Settlement Order Without Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

- - -

SCHEDULE A – DIVISION OF OTHER REAL ESTATE

A. Parcel 2: The parties own other real estate located at: Address City State Zip Parcel Identification Number (Tax Key Number)

Attached is a legal description of this property.

1. This property shall be awarded to the

A. Petitioner/Joint Petitioner A B. Respondent/Joint Petitioner B

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 property shall be placed on the market for sale.

A. Pending sale, the property shall be occupied, used, or managed by 1. Petitioner/Joint Petitioner A. 2. Respondent/Joint Petitioner B. 3. shared equally. 4. Other: B. Pending sale, the mortgage, taxes, and insurance shall be paid by 1. Petitioner/Joint Petitioner A. 2. Respondent/Joint Petitioner B. 3. shared equally.

4. Other: C. Pending sale, any necessary repairs, special assessments and other sale-related expenses shall be

paid by 1. Petitioner/Joint Petitioner A. 2. Respondent/Joint Petitioner B. 3. shared equally. 4. Other:

The money from the sale of this real estate 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 follow: a. Petitioner/Joint Petitioner A to receive %. b. Respondent/Joint Petitioner B to receive %.

B. Parcel 3: The parties own other real estate located at:

Address City State Zip Parcel Identification Number (Tax Key Number)

Attached is a legal description of this property.

1. This property shall be awarded to the

A. Petitioner/Joint Petitioner A B. Respondent/Joint Petitioner B

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 property shall be placed on the market for sale.

A. Pending sale, the property shall be occupied, used, or managed by 1. Petitioner/Joint Petitioner A. 2. Respondent/Joint Petitioner B. 3. shared equally. 4. Other: B. Pending sale, the mortgage, taxes, and insurance shall be paid by 1. Petitioner/Joint Petitioner A. 2. Respondent/Joint Petitioner B. 3. shared equally.

4. Other: C. Pending sale, any necessary repairs, special assessments and other sale-related expenses shall be

paid by 1. Petitioner/Joint Petitioner A. 2. Respondent/Joint Petitioner B. 3. shared equally. 4. Other:

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GF-175, 02/17 Declaration of Nonmilitary Service 15 U.S.C. §3931, 50 U.S.C. §3912 and §321.62, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

STATE OF WISCONSIN, CIRCUIT COURT, COUNTY

Declaration of Nonmilitary Service

Case No.

Plaintiff/ Petitioner:

-vs-

Defendant/ Respondent:

I, the undersigned, declare that:

1. I am the plaintiff/petitioner or plaintiff’s/petitioner’s attorney in this case.

2. This declaration is made for the purpose of obtaining a default judgment against the above nameddefendant/respondent.

3. I believe the defendant/respondent is not on active military duty at this time because:(Choose one)

I know the defendant/respondent personally and s/he has never given any indication that s/he is in service with the United States military or National Guard.

I contacted the defendant/respondent, who informed me on [Date] that s/he is not on active duty at this time.

I see the defendant/respondent regularly and therefore believe s/he is not on active duty at this time.

Other personal knowledge:

4. I obtained a certificate from the United States Department of Defense website showing that thedefendant/respondent is is not on active duty status. This certificate is attached.

5. I have attempted to determine military status but do not have sufficient information. I have no reason to believes/he is on active duty at this time. Describe efforts made:

Verification: Under penalty of perjury, I state that the above declaration is true, except as those matters stated upon information and belief, and as to those matters, I believe them to be true.

I am the: plaintiff/petitioner. attorney for the plaintiff/petitioner.

Plaintiff/Petitioner

Name Printed or Typed of Plaintiff/Petitioner

Date

Plaintiff’s/Petitioner’s Attorney

Name Printed or Typed of Plaintiff’s/Petitioner’s Attorney

Date

MILWAUKEE

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Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B:

FA-4161VA, 05/17 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 1 of 5

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

STATE OF WISCONSIN, CIRCUIT COURT, COUNTY

Enter the name of the petitioner/joint petitioner A.

IN RE: THE MARRIAGE OF Petitioner/Joint Petitioner A Name (First, Middle and Last)

and

Findings of Fact, Conclusions of Law, and

Judgment Without Minor Children

Divorce-40101 Legal Separation-40201

Case No.

Enter the name of the respondent/ joint petitioner B.

Respondent/Joint Petitioner B Name (First, Middle and Last)

Check divorce or legal separation.

Enter the case number.

FINAL HEARING

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.

A final hearing was conducted in this matter as follows:

1. Before Circuit Court Judge/Circuit Court Commissioner

2. Location 3. Date Time a.m. p.m.

APPEARANCES

In 1, check how the party appeared. If b, enter the name of the attorney.

1. Petitioner/Joint Petitioner A appeared in person appeared by phone did not appear AND

a. was self-represented. b. was represented by Attorney .

In 2, check how the party appeared. If b, enter the name of the attorney.

2. Respondent/Joint Petitioner B appeared in person appeared by phone did not appear AND

a. was self-represented. b. was represented by Attorney .

In 3, check a, or b. If b, enter the name of the individual who appeared.

3. Others appearing at the hearing: a. None. b. Other: .

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Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: Findings of Fact, Conclusions of Law, and Judgment-Without Minor Children Page 2 of 5 Case No.

FA-4161VA, 05/17 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 filing the

joint petition or the date of service of the summons and petition, whichever applies.

In 2, check a or b.

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.

In B.1, enter the requested information about Petitioner/Joint Petitioner A. If you do not know an answer, enter “unknown” in the blank.

B. Parties (as of the date of the final hearing) 1. Petitioner/Joint Petitioner A in this action is:

Name Address Address City State Zip Date of birth Gross monthly income $

In 2, enter the requested information about Respondent/Joint Petitioner B. If you do not know an answer, enter “unknown” in the blank.

2. Respondent/Joint Petitioner B in this action is: Name Address Address City State Zip Date of birth Gross monthly income $

In C1, check a or b.

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 or adopted together by the parties before or during the marriage

are as set forth in the petition.

In 2, check a or b and check which party is the father.

2. a. Neither party is currently pregnant. b. [Name of Party] is currently pregnant and

Petitioner/Joint Petitioner A Respondent/Joint Petitioner B is found to be the father.

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.

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.

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FA-4161VA, 05/17 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 3 of 5

In D1, check a, b or c. If c, enter the amount and interest rate and check 1 or 2. If 1, enter the date. If 2, enter payment amount, the frequency of the payment, and the date payments begin.

D. Past Due Maintenance. The amount of the past due arrearages for maintenance at the time of the final hearing is

a. none (zero). b. as agreed in the Marital Settlement Agreement or Proposed Marital Settlement. c. $ which shall earn interest at the rate of % per year and shall be paid as

1. a one-time payment to the WI SCTF made by [Date] , 20 . 2. through monthly income withholding by the WI SCTF in the amount of

$ beginning , 20 until the arrearages are paid in full.

Pursuant to §767.58(1)(c), Wis. Stats., a party receiving maintenance must notify the court and the payer within ten (10) days of remarriage.

In E, enter any other findings.

E. Other Findings:

CONCLUSIONS OF LAW AND JUDGMENT

In A, check 1 or 2. If 1, enter the effective date. If 2, enter the effective date.

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.

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.

B. Final Orders 1. The Marital Settlement Agreement dated or

Proposed Marital Settlement dated of the Petitioner/Joint Petitioner A Respondent/Joint Petitioner B

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’ order and is made the judgment of the court.

C. Lis Pendens

Any Lis Pendens filed in this action is released.

In D, check 1, 2, or 3. If 2 or 3, enter the former legal surname.

D. Legal Name Restoration 1. Neither party is awarded the right to use a former legal surname. 2. Petitioner/Joint Petitioner A is awarded the right to use a former legal surname of

.

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Page 4 of 5

3. Respondent/Joint Petitioner B is awarded the right to use a former legal surname of .

Note: If this is an action for legal separation, the court cannot allow either party 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 child support and/or 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 child support and/or 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 child support and/or 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.

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.

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Page 5 of 5

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. All payment of Guardian ad Litem (GAL) fees or fees for family court services shall be paid directly to the GAL or the agency which may enforce the order.

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

Title (Print or Type Name if not eSigned)

Date

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Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B:

FA-4161VB, 05/17 Parties Approval of 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.

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

STATE OF WISCONSIN, CIRCUIT COURT, COUNTY

Enter the name of the Petitioner/Joint Petitioner A.

IN RE: THE MARRIAGE OF Petitioner/Joint Petitioner A Name (First, Middle and Last)

and

Parties Approval of Findings of Fact,

Conclusions of Law, and Judgment

Without Minor Children

Divorce-40101 Legal Separation-40201

Case No.

Enter the name of the Respondent/Joint Petitioner B.

Respondent/Joint Petitioner B Name (First, Middle and Last)

Check divorce or legal separation.

Enter the case number.

The parties have each reviewed and approved the Findings of Fact, Conclusions of Law, and Judgment without minor child(ren) that was filed with the court on [Date] , 20 .

Petitioner/Joint Petitioner A

Respondent/Joint Petitioner B

Attorney

Attorney

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.

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Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B:

FA-4133V, 05/17 Portion of Judgment Regarding Surname §767.395, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

Page 1 of 1

STATE OF WISCONSIN, CIRCUIT COURT, COUNTY

Portion of Judgment Regarding Surname

IN RE: THE MARRIAGE OF Petitioner/Joint Petitioner A

and Respondent/Joint Petitioner B Case No.

The findings of fact, conclusion of law and judgment of divorce entered in the above-entitled action on , 20 , awards Petitioner/Joint Petitioner A Respondent/Joint Petitioner B the right to use a former legal surname of .

I certify that the foregoing portion of the judgment of divorce in the above-entitled action is true and accurate.

(COURT SEAL) BY THE COURT:

Clerk of Circuit Court/Deputy Clerk

Title (Print or Type Name if not eSigned)

Date