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PR IN T i n B LA CK i n k FA -6 04 , 1 0/0 6 S tip ula tio n a n d O rd er to A m end J u d gm ent fo r S uppo rt/ M ain te na nce /C usto d y/P la ce m ent § § 76 7.5 53, 7 67.5 9, 7 67 .4 5 1, 7 6 7.4 61 a n d 7 67.8 9 , W is co nsin S ta tu te s T h is f o rm s h all n ot b e m odif ie d . It m ay b e s u pple m en te d w it h a d dit io nal m ate ria l. P age 1 o f 3 E nte r t h e n am e o f t h e c o unty i n w hic h t h e o rig in al c ase w as f ile d . S TA TE O F W IS C O NSIN , C IR CUIT C O URT, C O UNTY M ark m arria g e o r p ate rn ity . I f p ate rn ity , e n te r i n itia ls o f c h ild . I n r e t h e M arria g e P ate rn it y o f ____ ___ ___ ___ E nte r t h e n am e, a d dre ss, a n d d ay tim e p hon e n um ber o f t h e p etitio ner o r j o in t p etitio ner f r o m t h e o rig in al c ase f ile . F or O ff ic ia l U se O n t h e f a r r ig h t, m ark t h e b o x f o r t h e c h an ge(s ) y o u a re r e q uestin g a n d e n te r t h e o rig in al c ase n um ber. P etit io ner/J o in t P etit io ner: Fir s t n am e M id dle n am e L ast n am e C urr e n t M ailin g A ddre ss C it y S ta te Z ip D aytim e p ho ne n u m ber V s. E nte r t h e n am e, a d dre ss, a n d d ay tim e p hon e n um ber o f t h e r e sp ond en t o r j o in t p etitio n er f r o m t h e o rig in al c ase f ile . R esp onden t/J o in t P etit io ner: F ir s t n am e M id dle n am e L ast n am e C urr e n t M ailin g A ddre ss C it y S ta te Z ip D aytim e p ho ne n u m ber M ark i f t h e S ta te o f W is c o nsin i s a p arty o r n ot. I f y o u a re u nsu re , y o u m ay c all y o ur l o cal C hild S up po rt A gen cy . T he S ta te o f W is co nsin ( C hild S upp ort A gency) is is n ot a p arty to t h is a ctio n . S tip ula tio n a n d O rd er t o : C han ge L eg al C usto d y C han ge P hys ic al P la cem en t C han ge C hil d S uppo rt C han ge M ain te n an ce C han ge F am il y S up port C han ge A rre ars B ala n ces O th er:_ ________ ___ ____ ___ ___ C ase N o. T he p artie s a gre e th at th e ju dgm ent in th is c a se s h ou ld b e c h ang ed a s f o llo w s, a nd th at t h e c o urt m ay e nte r th is s tip ula tio n a s a n o rd er w it h out a c o urt h earin g. 1 . M odif y C urr e n t F in an cia l O rd er(s ) A . T he c u rr e n t f in an cia l o rd er is a s f o llo w s: 1 . p a ys s u pport to f o r a. C hild S upport in th e a m ount o f $ % p er m onth . b . M ain te n an ce in th e a m ount o f $ % p er m onth . c . F am il y S upport in th e a m ount o f $ % p er m onth . d . A rre ars in th e a m ount o f $ % p er m onth . e . A rre ars In te re st in th e a m ount o f $ % p er m onth . f . O th er F in an cia l O rd ers : 2 . N o s u pp ort is c u rre ntly o rd ere d. B . F in an cia l O rd er C han g es: T he p artie s a gre e th at s u pport o rd ers s h all b e c h a nged a s f o llo w s: 1 . s h all m ake p a ym ents t o b eg in n in g th e f ir s t d a y o f th e m onth o f , 2 0 fo r a . C hild S upport in th e a m ount o f $ per m onth . b . M ain te n an ce in th e a m ount o f $ p er m onth . c . F am il y S upport in th e a m ount o f $ p er m onth . d . A rre ars P aym en t in t h e a m ount o f $ p er m onth . e . A rre ars In te re st in th e a m ount o f $ p er m onth . f . O th er F in an cia l O rd ers : 2 . N o s u pp ort s h a ll b e o rd ere d f r o m e it h er p arty a t th is tim e b eca use I f y o u a re m odif y in g f in an cia l o rd ers , c h eck 1 a n d c o m ple te A -D . I n A , c h eck 1 o r 2 . I f 1 , e n te r t h e n am es o f t h e p ay er a n d p ay ee a n d i n dic ate w hat i s c u rre n tly o rd ere d b y m ark in g a ll t h at a p p ly i n a -f a n d e n te rin g t h e a m ount o f t h e cu rre n t o rd er. In B , c h eck 1 o r 2 t o i n dic ate t o w hat a m ount y o u w an t t h e o rd er c h an ged . I f 1 , e n te r t h e n am es o f t h e p ay er a n d p ay ee, t h e d ate t h e o rd er s h all b e e ffe ctiv e, c h ec k a ll t h at a p ply i n a -f, a n d e n te r t h e n ew a m ount. I f 2 , e n te r t h e r e aso ns. FA -6 04 , 1 0/0 6 S tip ula tio n a n d O rd er to A m end J u d gm ent fo r S uppo rt/ M ain te na nce /C usto d y/P la ce m ent § § 76 7.5 53, 7 67.5 9, 7 67 .4 5 1, 7 6 7.4 61 a n d 7 67.8 9 , W is co nsin S ta tu te s T h is f o rm s h all n ot b e m odif ie d . It m ay b e s u pple m en te d w it h a d dit io nal m ate ria l. P age 2 o f 3 C . C hild S upport C alc u la tio n: T he n e w o rd er f o r c h ild s u pp ort is b ase d o n 1 . N o c h an ge in c h ild s u pp ort w as m ade. 2 . D W D C hapte r 4 0 C hild S up port P erc e nta ge o f In co m e S ta ndard . ( B ase d o n G ro ss I n co m e – 1 7% f o r o n e c h ild , 2 5% f o r t w o c h ild re n, 2 9% f o r t h re e c h il d re n, 3 1% f o r f o ur c h il d re n, 3 4 % f o r f iv e o r m ore c h ild re n) 3 . T his a m ount d e via te s f r o m th e D W D 4 0 C hild S up port S ta n dard a m oun t w hic h w ou ld b e u nfa ir b eca use c h ild s u pport s h ou ld b e c a lc u la te d u sin g t h e: a . s p lit - p la ce m ent c a lc u la tio n b. s h are d-p la ce m ent c a lc u la tio n c. s e ria l- fa m il y p aye r c a lc u la tio n d. lo w -in co m e p a ye r c a lc u la tio n e. h ig h-in co m e p a ye r c a lc u la tio n f . o th er D . P aym en ts 1. N o p a ym ents a re o rd ere d to b e m ade. 2 . S ha ll b e m ade to th e W is co nsin S upp ort C oll e ctio ns T ru st F und ( W I S C TF) a t B ox 7 420 0, M ilw auke e, W is co nsin 5 3 274-0 20 0. P aym ents s h all b e m ade: a . D ir e ctly f r o m th e p a ye r t o W I S C TF (o nly a llo w ab le if s elf -e m plo ye d ). b. B y in co m e a ssig nm ent f r o m th e p a ye r’s e m plo ye r a s in d ic a te d b e lo w : Em plo ye r n am e: Addre ss o f p a yro ll o ffic e : Cit y : S ta te : Z ip : Pho ne: Fax: 3 . P aym ents s h a ll b e m ade d ir e ctly f r o m o ne p arty t o th e o th er ( n ot a llo w ab le f o r c h ild s u pport, f a m il y s u pport, o r m ain te n an ce). 2 . M odif y L eg al C usto d y O rd er(s ): T he le ga l c u sto d y o f th e f o llo w in g c h ild re n : is c h anged a s f o llo w s: A . T o jo in t le ga l c u sto d y w it h b o th p are nts . B . T o s o le le ga l c u sto d y w it h [n am e o f p are nt] C . O th er: 3 . M odif y P hysic al P la c em en t O rd er(s ): T he p h ys ic a l p la ce m ent o f th e f o llo w in g c h ild re n : _ ___________ is c h an ged a s f o llo w s: A . T o s h are d p h ys ic a l p la ce m ent a cco rd in g t o th e f o ll o w in g s ch ed ule : S ee a tta c h ed B . T o p rim ary p h ys ic a l p la ce m ent w it h (n am e o f p are nt) _ __________ _ a nd ( n am e o f p are nt) _ _ __________ re ce iv in g p erio ds o f p h ys ic a l p la ce m ent ( v is it a tio n) a cco rd in g to t h e fo llo w in g s ch e du le : S ee a tta c h ed . C . T o r e quir e p la ce m ent b e s u perv is e d u nsu p erv is e d a s f o llo w s ): S ee a tta c h ed . D . A cco rd in g to t h e a tta ch ed p la ce m ent s ch edu le . E. O th er: S ee a tta c h ed . I f y o u a re m odif y in g L eg al C usto d y, c h ec k 2 , e n te r t h e n am es o f t h e c h ild re n , a n d c h eck & c o m ple te A , B , o r C . I n C , c h eck 1 , 2 , o r 3 . I f 2 , c h eck t h e b ox f o r t h e p erc en ta g e s ta n dard u se d . I f 3 , c h eck w hic h a p plie s i n a -f. I f y o u a re m odif y in g P hysic al P la cem en t, c h ec k 3 , e n te r t h e n am es o f t h e c h ild re n , c h eck & c o m ple te A , B , C , D , o r E a n d e n te r t h e n ew o rd ers . I n D , c h eck 1 , 2 , o r 3 . I f 2 , c h eck a o r b . I f b , c o m ple te t h e p ay er’s e m plo yer i n fo rm atio n. FA -6 04 , 1 0/0 6 S tip ula tio n a n d O rd er to A m end J u d gm ent fo r S uppo rt/ M ain te na nce /C usto d y/P la ce m ent § § 76 7.5 53, 7 67.5 9, 7 67 .4 5 1, 7 6 7.4 61 a n d 7 67.8 9 , W is co nsin S ta tu te s T h is f o rm s h all n ot b e m odif ie d . It m ay b e s u pple m en te d w it h a d dit io nal m ate ria l. P age 3 o f 3 4 . A ddit io nal C han ges a re a s f o ll o w s: S ee a tta c h ed . T he f o rm er w if e /m oth er m ust s ig n a n d p rin t h er n am e. E nte r t h e d ate o n w hic h s h e s ig n ed h er n am e. N ote : T his s ig n atu re d oes n o t n eed t o b e n ota riz ed . S ig natu re P rin t o r T yp e N am e D ate T he f o rm er h usb an d/f a th er m ust s ig n a n d p rin t h is n am e. E nte r t h e d ate o n w hic h h e s ig n ed h is n am e. N ote : T his s ig n atu re d oes n o t n eed t o b e n ota riz ed . Sig natu re P rin t o r T yp e N am e D ate T H E C O URT O RDER S: 1. T his s tip ula tio n is a ppro ve d a nd th e ju dgm ent is a m ended a cco rd in gly . 2 . A ll p ro vis io ns o f th e p re vio u s ju dgm ent n ot a m ended b y th is o rd er r e m ain in f u ll e ffe ct. B Y T H E C O URT: F or C ou rt U se O nly _ ___ ___ ___ __ ___ ___ ___ _____ ___ ___ __ ___ ___ ___ __ C ir c u it C ourt J u dge/C ourt C om m is s io ner __ ___ __ ___ ___ ___ _____ ___ ___ __ ___ ___ ___ __ P rin t o r T yp e N am e __ ___ __ ___ ___ ___ _____ ___ ___ __ ___ ___ ___ __ D ate S ta te o f W is co nsin , C hild S upport A gen cy If e ith er p arty i s r e ceiv in g p ublic a ssis ta n ce o r t h ere i s a c ase w ork er f r o m t h e C hild S up po rt A gen cy a ssig n ed t o y o ur c ase , y o u m ust t a k e t h is a g re e m en t t o t h e C hild S upp ort A gen cy i n y o ur c o unty f o r t h eir a p pro val. I f n ot, m ark n ot r e q uir e d . A ppro ve d N ot A ppro ve d N ot R equ ir e d Auth oriz e d S ig natu re P rin t o r T yp e N am e D ate I f y o u a re m odif y in g a n yth in g e ls e , c h ec k a n d c o m ple te 4 .