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FA-4109V, 05/17 Petition -W ithout Minor Children §767.215, W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 Enter the name of the county in which you are filing this case. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Enter your name (you are the petitioner ). IN RE : THE MARRIAGE OF Petitioner Name (First, Middle and Last) Address Address City State Zip and Enter your address. On the far right, check divorce or legal separation. Petition Without Minor Children Divorce -40101 Legal Separation -40201 Case No. Enter the respondent’s name ( the other party is the respondent ). Respondent Name (First, Middle and Last) Address Address City State Zip Enter the respondent’s address. Note: Leave case number blank; the clerk will add this. I am the petitioner in this action. Enter your date of birth [month, day, year]. A. I am providing the following information about myself: 1. Date of birth . For 2, 3, 4, and 5, check yes or no. Military personnel: Please see Basic Guide to Divorce/Legal Separation. 2. Immediately before filing this petition, I will have lived in this county for 30 days or more. Yes No 3. Immediately before filing this petition, I will have lived in the state of Wisconsin for 6 months or more. Yes No 4. I am currently on active duty as a member of the Armed Forces of the United States of America or its allies. Yes No For 5, check yes or no. 5. I am currently pregnant. Yes No Enter the respondent’s date of birth [month, day, year]. B. I am providing the following in formation about the respondent : 1. Date of birth . For 2, 3, 4, and 5, check yes or no. Military personnel: Please see Basic Guide to Divorce/Legal Separation. 2. Immediately before filing this petition, the respondent will have lived in this county for 30 days or more. Yes No 3. Immediately before filing this petition, the respondent will have lived in the state of W isconsin for 6 months or more. Yes No 4. The respondent is currently on active duty as a member of the Armed Forces of the United States of America or its allies. Yes No 5. The respondent is currently pregnant. Yes No Petition -Without Minor Children Page 2 of 3 Case No. ________________ FA-4109V, 05/17 Petition -W ithout Minor Children §767.215, W isconsin Sta tutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 Enter the date [month, day, year], city, and state in which you were married. C. I am providing the following marriage information: 1. The respondent and I were married on [Date] . 2. We were married in [City ] [State] . 3. I am filing for Check a or b. If b, explain why you are filing for legal separation and not a divorce. a. Divorce: This marriage is irretrievably broken. b. Legal Separation : This marriage is broken and the reason I am requesting a legal separation and not a divorce is 4. Previous Actions 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. This is the first time that either party 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 Check yes or no. If no, respond to 5a -5d with information about your most recent previous marriage. 5. This is my first marriage. Yes No a. I 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. I was also previously married to f. The marriag e was terminated by divorce. death. g. Date of the divorce or death h. The divorce was granted in: Name of court City State If you had more than 2 previous marriages, repeat 5e -5h on an additional sheet. Check yes or no. If no, respond to 6a -6d with information about the respondent ’s most recent previous marriage, if known. 6. This is the respondent’s first marriage. Yes No a. The respondent 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 respondent was also previously married to f. The marriage was terminat ed by divorce. death. g. Date of the divorce or death If the respondent’s had an additional previous marriage, respond to 6e-6h. h. The divorce was granted in: Name of court City State If the respondent had more than 2 previous marriages, repeat 6e -6h on an additional sheet. Check a or b. If b, write the names and dates of birth of all adult children born to a party or adopted by you and the respondent during the marriage. D. I am providing the following information regarding children: 1. a. No children were born to or adopted together by either party before or during our marriage. b. All children, who are currently age 18 or older, born to a party , or adopted together by me and the other party during the marriage include: Name of Child Date of Birth Petition -Without Minor Children Page 3 of 3 Case No. ________________ FA-4109V, 05/17 Petition -W ithout Minor Children §767.215, W isconsin Sta tutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 Check yes or no. If yes, attach a copy of the written agreement to this petition. 2. The respondent and I 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 I have attached a copy of the written agreement to this petition. b. No I ASK THAT THE COURT : If you are requesting maintenance (spousal support) at this time, check yes. If not, check no. 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 Neither party 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, 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 § 785.04 , WIS. STATS. These PROHIBITIONS apply until the action is dismissed, a final judgment in the action is entered, or the court order s otherwise. Sign and print your name. Enter the date on which you signed your name. Note: This document does not need to be notarized. ► Signature Print or Type Name Date