Joint Petitioner A: Joint Petitioner B: FA-4110V, 05/17 Joint Petition-W ith Minor Children §§767.215 and 822.29, W isconsin Statutes
This form shall not be modified. It may be supplemented with additional mat erial.
Page 1 of 7
Enter the name of the
county in which you are
filing this case. STATE OF WISCONSIN, CIRCUIT COURT,
COUNTY
Enter Joint Petitioner A’s
name and address.
IN RE: THE MARRIAGE OF
Joint Petitioner A
Name (First, Middle and Last)
Address
Address
City State Zip
and
On the far right, check
divorce or legal
separation.
Amended
Joint Petition
With Minor Children
Divorce-40101
Legal Separation-40201
Case No.
Enter Joint Petitioner B’s
name and address. Joint Petitioner
B
Name (First, Middle and Last)
Address
Address
City State Zip
Note: Leave case number
blank; the clerk will enter it.
Enter Joint Petitioner A’s
date of birth [Month, Day,
Year]. A. We are providing the following information about Joint Petitioner A:
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, Joint Petitioner A will have lived in this county
for 30 days or more.
Yes No
3. Immediately before filing this petition, Joint Petitioner A will have lived in the state of
Wisconsin for 6 months or more.
Yes No
4. Joint Petitioner A is currently on active duty as a member of the Armed Forces of the
United States of America or its allies.
Yes No
5. Joint Petitioner A is currently pregnant.
Yes No
Enter Joint Petitioner B’s
date of birth [Month, Day,
Year]. B. We are providing the following information about Joint Petitioner B:
1. Date of birth .
2. Immediately before filing this petition, Joint Petitioner B will have lived in this c ounty
for 30 days or more.
For 2, 3, 4 and 5, check yes
or no.
Military personnel:
Please see Basic Guide to
Divorce/Legal Separation. Yes
No
3. Immediately before filing this petition, Joint Petitioner B will have lived in the st ate of
Wisconsin for 6 months or more.
Yes No
4. Joint Petitioner B is currently on active duty as a member of the Armed Forces of the
United States of America or its allies.
Yes No
5. Joint Petitioner B is currently pregnant.
Yes No
C. We are providing the following marriage information:
Joint Petitioner A: Joint Petitioner B: Joint Petition – With Minor Children Page 2 of 7 Case No.
FA-4110V, 05/17 Joint Petition-W ith Minor Children §§767.215 and 822.29, W isconsin Statutes
This form shall not be modified. It may be supplemented with additional mat erial.
Page 2 of 7
Enter the date [month, day,
year], city, and state in
which you were married. 1. We were married on [Date] .
2. We were married in [City] [State] .
3. We are filing for
Check a or b. If b, explain
why you are filing for a
legal separation and not a
divorce. 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
In 4, 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 have filed for divorce or legal separation from
each other in W isconsin or in any other state:
a. Yes
b. No: County
State
Case No.
Has this case been dismissed? Yes No
In 5, check yes or no.
5. This is Joint Petitioner A’s first marriage. Yes No
If no, respond to 5a-5d
with information about
Joint Petitioner A’s most
recent previous marriage. a . Joint Petitioner A 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
If Joint Petitioner A had
an additional previous
marriage, respond to 5e- 5h.
e . Joint Petitioner A 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 Joint Petitioner A had more than 2 previous marriages, repeat 5e-5h on an
additional sheet.
Check yes or no.
6. This is Joint Petitioner B’s first marriage. Yes No
If no, respond to 6a-6d
with information about
Joint Petitioner B’s most
recent previous marriage. a. Joint Petitioner B 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
If Joint Petitioner B had
an additional previous
marriage, respond to 6e-6h.
e. Joint Petitioner B 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 Joint Petitioner B had more than 2 previous marriages, repeat 6e-6h on an
additional sheet.
In D.1, enter the name and
date of birth [month, day,
year] for each minor
child.
If you and the other party
do not have minor
children together, check
None.
D. We are providing the following information regarding our children:
1. Minor Children that we have together
a. The minor children (age 17 or younger) of me and the other party (born to or
adopted) before or during our marriage are
b. None.
Name of Minor Child Date of Birth
Joint Petitioner A: Joint Petitioner B: Joint Petition – With Minor Children Page 3 of 7 Case No.
FA-4110V, 05/17 Joint Petition-W ith Minor Children §§767.215 and 822.29, W isconsin Statutes
This form shall not be modified. It may be supplemented with additional mat erial.
Page 3 of 7
In 2, enter the name and
date of birth [month, day,
year] for each adult child.
If you do not have adult
children, check None.
2. Adult Child(ren ) that we have together
a. The adult child(ren) (age 18 or older) of me and the other party (born to or
adopted) before or during our marriage are
b. None.
Name of Adult Child Date of Birth
In 3, enter the name and
date of birth [month, day,
year] for each other child
and indicate the parent.
If you do not have other
children, check None. 3. Other children
a. Other child(ren) born or adopted during this marriage by either party.
b. None.
Name of Child Date of Birth Parent
Check no or yes. If yes,
enter county and case no. Has paternity been established? No
Yes, County Case No.:
In 4, check yes or no. 4. Have the minor child(ren) lived in W isconsin 6 months or more with at least one of
the parents?
Yes No
In 5, enter the current address
of the minor children. If the
children currently reside at
separate addresses, provide
those addresses on an
additional sheet. 5. The current address of the minor child(ren) is/are
Address
Address
City State Zip
In 6, enter any previous
addresses for the minor
children living with the
parents during the past 5
years. If none check
“none.” 6. Previous addresses for the minor child(ren) is/are
None (the children have lived at the current address for t he last five years).
Address
Address
City State Zip
If the children have lived in
more than 2 places over the
past 5 years, provide those
addresses on an additional
sheet.
Address
Address
City State Zip
In 7, check yes or no. 7. Currently, or during the last 5 years, one or more of the minor children lived with a
person other than a parent.
Yes No
If yes, enter the name of
that minor child and the
name and address of the
person with whom that
child lived. Child
Person
Address
Address
City State Zip
Attach an additional sheet,
if necessary. Child
Person
Address
Address
City State Zip
Child
Person
Address
Joint Petitioner A: Joint Petitioner B: Joint Petition – With Minor Children Page 4 of 7 Case No.
FA-4110V, 05/17 Joint Petition-W ith Minor Children §§767.215 and 822.29, W isconsin Statutes
This form shall not be modified. It may be supplemented with additional mat erial.
Page 4 of 7
Address
City State Zip
In 8, check a or b.
8. We have been (or we have been aware of others who have been) a party, witness or
participated in another way in other past court proceedings concerning the custody of
or physical placement or visitation with the minor children listed in D1 or D3 , in
Wisconsin or in any other state.
If a, enter the name of the
court in which it was
ordered, the case number
assigned to it, and date it
was ordered. a. Yes and the paternity, custody, physical placement, or visitation order was
granted in: Name of court
Case Number Date
b. No.
In 9, check a or b.
9. We are aware of a proceeding that could affect the current proceeding, including
proceedings for enforcement and proceedings related to domestic violence, protective
orders, termination of parental rights, or adoption concerning the children listed in D1
or D3 , in Wisconsin or any other state.
If a, enter the name of the
court, the case number
assigned to it, and the nature
of the proceeding.
a. Yes and the proceeding that could affect the current proceeding is in:
Name of court
Case Number
Nature of Proceeding
b. No.
In 10, check a or b. If a,
attach a copy of the
written agreement. 10.
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), child support,
legal custody or physical placement of the minor children, 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:
If you are requesting
maintenance, child
support and/or family
support at this time,
check yes. If not, check
no. 1. Grant a judgment as requested.
2. Enter an order granting maintenance, child support and/or family support.
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 restr aint 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.
3. Establishing a residence with a minor child of the parties outside the s tate of Wisconsin or more than 150
miles from the residence of the other party within the state without the con sent of the other party or an order
of the court.
Joint Petitioner A: Joint Petitioner B: Joint Petition – With Minor Children Page 5 of 7 Case No.
FA-4110V, 05/17 Joint Petition-W ith Minor Children §§767.215 and 822.29, W isconsin Statutes
This form shall not be modified. It may be supplemented with additional mat erial.
Page 5 of 7
4. Removing a minor child of the parties from the state of Wisconsin f or more than 90 consecutive days
without the consent of the other party or an order of the court.
5. Concealing a minor child of the parties from the other party without t he consent of the other party or an
order of the court.
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.
A violation of paragraphs 3, 4, or 5 above is not a contempt of cou rt if the court finds that the action was
taken to protect a party or a minor child of the parties from physical abuse b y the other party and that there
was no reasonable opportunity under the circumstances for the party to obtain an order authorizing the
action.
These PROHIBITIONS apply until the action is dismissed, a final judgment in th e action is entered, or the
court orders otherwise.
STOP!
Take this document to a Notary Public BEFORE signing.
Joint Petitioner A must be
sworn by a Notary Public
before signing, printing
name and dating the
document in front of the
Notary Public.
Joint Petitioner A
Print or Type Name
Date
Have the Notary Public
sign, date, and seal the
document. State of
County of
Subscribed and sworn to before me on
Notary Public/Court Official
Name Printed or Typed
My commission/term expires:
(SEAL)
STOP!
Take this document to a Notary Public BEFORE signing.
Joint Petitioner B must be
sworn by a Notary Public
before signing, printing
name and dating the
document in front of the
Notary Public.
Joint Petitioner B
Print or Type Name
Date
Have the Notary Public
sign, date, and seal the
document. State of
County of
Subscribed and sworn to before me on
Notary Public/Court Official
Name Printed or Typed
My commission/term expires:
(SEAL)
Joint Petitioner A: Joint Petitioner B: Joint Petition – With Minor Children Page 6 of 7 Case No.
FA-4110V, 05/17 Joint Petition-W ith Minor Children §§767.215 and 822.29, W isconsin Statutes
This form shall not be modified. It may be supplemented with additional mat erial.
Page 6 of 7
Wisconsin Department of Children and Families Child Support Percentage of Income Standards
Authority and Purpose
Wis. Stats. § 49.22(9) requires the Department to adopt and publish a standard, based upon a percentage
of the gross income and assets of either or both parents, to be used by courts in determining child support
obligations. Chapter DCF 150 of the Wisconsin Administrative Code establishes Wisconsin's perce ntage
of income standard for child support. It is based upon the principle that the child's standard of living
should, to the degree possible, be the same as if the child's parents were living together.
Chapter DCF 150 defines the income upon which the support obligation is based, and sets the percentages
of income for computing the support obligation based upon a number of children. It also explains optional
procedures for adjusting the obligation when the parents share placement, when the parent has an
obligation to support another family, or when the payer has particularly high or low income.
Applicability
The percentage standard applies to any temporary and final order for child support, including chil d
support stipulations agreed to by both parents and modifications of existing child support orders. When
used to calculate family support, the amount determined under the standard should be increased by the
amount necessary to provide a net family support payment, after state and federal income taxes are paid,
of at least the amount of a child support payment under the standard.
Definition of Income and Assets
Chapter DCF 150 defines gross income as income from any source, whether or not it is reported or tax ed
under federal law. The income can be in the form of money, property, or services. Public assistance or
child support received from previous marriages or business expenses, which the court determines are
reasonably necessary for the production of income or operation of a business are subtracted, and wages
paid to dependent household member are added to determine "gross income available for child support."
The court may also determine that income may be "imputed" (assumed at a given level) based on earning
capacity and/or assets, and that imputed income is added to the gross income for the calculation of the
support obligation.
THE PERCENTAGE STANDARD
The percentages are: 17% for one child
25% for two children
29% for three children
31% for four children
34% for five or more children
Wisconsin Statutes require temporary and final support orders to be expressed as fixed sum in most
situations.
For further details, refer to Chapter DCF 150 of the Wisconsin Administrative Code and Wisconsin Sta tute 767
Actions Affecting the Family. (Choose “Wisconsin Law” on
http://www.legis.state.wi.us )
Joint Petitioner A: Joint Petitioner B: Joint Petition – With Minor Children Page 7 of 7 Case No.
FA-4110V, 05/17 Joint Petition-W ith Minor Children §§767.215 and 822.29, W isconsin Statutes
This form shall not be modified. It may be supplemented with additional mat erial.
Page 7 of 7
Statutory Factors Courts May Consider In Determining Child Support Awards for Paternity, Divorce, or Legal Separation
§767.511, Child Support.
(1m) Upon request by a party, the court may modify the amount of child support payments determined
under §767.511(1j), if, after considering the following factors, the court finds by the gr eater weight of the
credible evidence that use of the percentage standard is unfair to the child or to any of the p arties:
(a) The financial resources of the child.
(b) The financial resources of both parents.
(bj) Maintenance received by either party.
(bp) The needs of each party in order to support himself or herself at a level equal to or greater than that
established under 42 USC 9902 (2).
(bz) The needs of any person, other than the child, whom either party is legally obligated to support.
(c) If the parties were married, the standard of living the child would have enjoyed had the marri age not
ended in annulment, divorce or legal separation.
(d) The desirability that the custodian remain in the home as a full-time parent.
(e) The cost of day care if the custodian works outside the home, or the value of custodial services
performed by the custodian if the custodian remains in the home.
(ej) The award of substantial periods of physical placement to both parents.
(em) Extraordinary travel expenses incurred in exercising the right to periods of physical placem ent under
§767.41.
(f) The physical, mental and emotional health needs of the child, including any costs for health
Insurance as provided for under sub. (4m).
(g) The child's educational needs.
(h) The tax consequences to each party.
(hm) The best interests of the child.
(hs) The earning capacity of each parent, based on each parent's education, training and work experience
and the availability of work in or near the parent's community.
(i) Any other factors which the court in each case determines are relevant.