PRINT in INK
Enter the name of the
county in which this case
is filed. STATE OF WISCONSIN, CIRCUIT COURT,
COUNTY For Official Use
Enter the name of the
petitioner. If joint
petitioners, enter the name
of the wife. In RE: The marriage of
Petitioner/Joint Petitioner-Wife :
First name Middle name Last name
and Proposed Marital Settlement
Without Minor Children
D ivorce-40101
Legal Separation-40201
Case No. Enter the name of the
respondent. If joint
petitioners, enter the name
of the husband. Respondent/Joint Petitioner-Husband :
First name Middle name Last name
Check divorce or legal
separation.
Enter the case number.
I REQUEST THAT THE COURT GRANT THE FOLLOWING:
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
B. MAINTENANCE (Spousal Support)
1. For the Wife:
a. The wife gives up her right to receive maintenance. She understands that by giving up
maintenance at this time, she may never ask for maintenance.
b. The wife is not requesting maintenance at this time, but leaves open her right to request it
until . Her right to request maintenance is limited to:
1. the following circumstance(s) only:
2. any appropriate substantial change in circumstance.
c. The husband shall pay maintenance to the wife in the amount of $
per month beginning on the first day of the month of , 20 .
Maintenance shall end on the last day of the month of 20
or until the wife remarries, dies, or by court order, whichever comes first.
2. For the Husband:
a. The husband gives up his right to receive maintenance. He understands that by giving
up maintenance at this time, he may never ask for maintenance.
b. The husband is not requesting maintenance at this time, but leaves open his right to
request it until . His right to request maintenance is limited to:
1. the following circumstance(s) only:
2. any appropriate substantial change in circumstance.
c. The wife shall pay maintenance to the husband in the amount of $ per month
beginning on the first day of the month of 20 .
Maintenance shall end on the last day of the month of , 20 ,
or until the husband remarries, dies, or by court order, whichever comes first.
FA-4153V, 01/09 Proposed Marital Settlement Without Minor Children §767.34, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 1 of 7Check 1 or 2.
If 2, enter the reason
you are asking for a
legal separation and
not a divorce.
Check a, b, or c.
If b, enter a date and
choose 1 or 2.
If 1, enter the reasons.
If c, enter the
maintenance amount
and the month and year
the payments should
begin and end.Check a, b, or c.
If b, enter a date and
choose 1 or 2.
If 1, enter the reasons.
If c, enter the
maintenance amount
and the month and year
the payments should
begin and end.
Proposed Marital Settlement Without Minor Children Page 2 of 7 Case No. Error: Reference source not found __________
3. Payments shall be made:
a. No payments are ordered to be made.
b. to the Wisconsin Support Collections Trust Fund (WI SCTF) at Box 74200,
Milwaukee, Wisconsin 53274-0200:
1. directly from the payer to WI SCTF ( only allowable if self-employed ).
2 . by income assignment from the payer’s employer as indicated below:
Employer name
Address of payroll office
City State Zip
Phone Fax
4. Arrearages for Previously Ordered Maintenance: The amount of the maintenance
arrears owed to a party shall be paid 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 to zero.
d. I propose that the amount of the arrears:
1. shall be set as follows: $
2. shall be determined by the court at the time of the final hearing.
and shall be paid and earn interest at the rate of % per year and
payment shall be made as:
A. a one-time payment to the WI SCTF made by (date) .
B. through monthly income withholding by the WI SCTF in the amount of
$ beginning on the first day of the month of
, 20 until the arrearages are paid in full.
C. MEDICAL INSURANCE
No later than the date of the final hearing, each party shall notify the other party in writing of
the availability of COBRA or other continuation benefits under their current health care policy.
D. DEBTS AND LIABILITIES
The following is a listing of ALL the debts and liabilities that we presently owe (either individually
or as a couple) and who I propose shall be responsible for the payment of each debt:
Creditor’s Name Balance To be Paid
by Wife To be Paid
by Husband
$
$
$
$
$
$
$
$
$
$
$
$
$
The parties understand that:
Each party assigned a debt shall be fully responsible for that obligation and
shall not make any demands upon the other party concerning that debt.
Any debt not listed shall be the responsibility of the party who incurred it and that party
shall not make any demands upon the other party concerning that debt.
FA-4153V, 01/09 Proposed Marital Settlement Without Minor Children §767.34, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 2 of 7For each debt owed
individually or jointly,
write the name, current
balance, and check
who will be
responsible for
payment.
Note: Any and all
debts disclosed on the
parties’ Financial
Disclosure Statements
that are still unpaid
should be included
here and divided
between the parties.
Any new debts
incurred should also be
listed and divided.
If more space is
necessary, attach
additional sheets.Check a, b, c or d.
If d, check 1or 2. If 1,
enter arrearage
amount. If 2, enter the
interest rate and check
A or B. If A, enter the
date. If B, enter the
amount of the monthly
payment and the
month and year the
payments shall begin.
Note: An arrearage is
an amount ordered that
has not been paid and
is overdue.Enter a or b.
If b, check 1 or 2. If 2,
enter the employer
information.
Proposed Marital Settlement Without Minor Children Page 3 of 7 Case No. Error: Reference source not found __________
Creditors are NOT bound by this proposal and each party remains liable to creditors for
all marital debts.
Any party who suffers a loss because of a failure of the other party to pay an assigned
debt may enforce that obligation by a motion for contempt of court.
E. PERSONAL PROPERTY DIVISION
1. Division: The parties agree to the final personal property division as indicated below:
FA-4153V, 01/09 Proposed Marital Settlement Without Minor Children §767.34, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 3 of 7List the property and check if the wife or husband
will have permanent use of the property once the
divorce/legal separation is final. Who will have possession?
Wife = W Husband = H
Household Items W H
Automobiles
Year, Make, Model W H
Life Insurance
Name of Company & Policy # W H
Business Interests
Name of Business & Address W H
Securities: Stocks, Bonds, Mutual Funds, Commodity Accounts
Name of Company & # of shares W H
Pension, Retirement Accounts,
Deferred Compensation, 401K Plans, IRAs, Profit Sharing, etc.
Name of Company & Type of Plan W H
Cash and Deposit (Savings & Checking) Accounts
Name of Bank or Financial Institution W H
Other Personal Property
Description of Asset W H
Complete this section with
as much detail as possible.
Note: There are two types
of property. “Real estate”
includes such things as
homes and land. “Personal
property” includes all other
things such as vehicles,
clothing and other personal
items, furniture, bank
accounts, and retirement or
investment accounts.
Proposed Marital Settlement Without Minor Children Page 4 of 7 Case No. Error: Reference source not found __________
See attached
2. Exchange: The following items still need to be exchanged between the parties :
a. None: All personal property has already been exchanged to the satisfaction of
both parties.
b. List of items:
The exchange of personal property shall be made by (date)
according to the following arrangements:
Any item of personal property not listed in #2(b) above shall be awarded to the
party who has possession at the time of the final hearing.
F. DIVISION OF REAL ESTATE
1. Neither party owns any real estate at this time.
2. One or both parties own real estate at this time.
a. Primary Residence : The parties own a primary residence located at:
Address
City State Zip
Parcel Identification Number (Tax Key Number)
Attached is a legal description of this property.
1. The primary residence shall be awarded to the:
A. wife
B. husband
and that party shall be responsible for outstanding financial obligations,
and the other party shall be held harmless from any liability. Other
provisions including refinancing requirements, if any:
2. The residence shall be placed on the market for sale. See attached
A. Pending sale, the mortgage, taxes, and insurance shall be paid by:
1. wife.
2. husband.
3. shared equally.
4. shared as follows:
B. Pending sale, any necessary repairs, special assessments and other
sale-related expenses shall be paid by:
1. wife.
2. husband.
3. shared equally.
4. shared as follows:
The money from the sale of this residence shall be used to pay the
usual costs of a sale and prorations, and any balance on the existing
mortgage. Upon payment of all costs, the proceeds left from the sale
shall be divided between the parties as follows:
a. The wife to receive %.
b. The husband to receive %.
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 agreement alone will not transfer title
to one party or the other, but such a transfer requires a fully executed Quit Claim Deed
FA-4153V, 01/09 Proposed Marital Settlement Without Minor Children §767.34, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 4 of 7Check 1 or 2.
If 2, and the parties
own a primary
residence, check a.
If a, enter the address
and Parcel
Identification Number,
which can be found on
your real estate tax bill.
Attach a copy of the
legal description.
Check 1 or 2.
If 1, check A or B and
enter other provisions,
if any.
If 2, check 1, 2, 3, or 4
in A or 1, 2, 3, or 4. in
B for the responsibility
for other expenditures
that occur while the
property is being sold
or refinanced.
Enter the percentage
each party shall receive
in a and b. The total
amount must equal 100
%.
If the parties own other
real estate (including
any timeshare
interests), check b,
complete the attached
Schedule A. Check a or b. If b, list
the items and indicate
when and how any
exchange of personal
property will take
place.
Note: Any and all assets
disclosed on the parties’
Financial Disclosure
Statements should be
included here and divided
between the parties.
If the parties have
disposed of an asset from
the time the Financial
Disclosure was done, to
the final hearing, please
indicate what was
disposed and what
happened to it.Note: If you have already
divided the property, you
must still disclose how
you divided it below.
Proposed Marital Settlement Without Minor Children Page 5 of 7 Case No. Error: Reference source not found __________
and a Wisconsin Real Estate Transfer Return signed by the parties. The party awarded
a parcel of real estate shall be responsible for having the necessary documents prepared.
G. EQUALIZATION OF MARITAL PROPERTY DIVISION
1. No payment is required to be made to equalize the marital property division because:
a. the property and debt division are equalized to the satisfaction of the parties.
b. equalization has been accomplished through a division of real estate sale
proceeds.
2. A payment of $ is required to equalize the marital property division.
a. This payment shall be made by the:
1. wife to the husband.
2. husband to the wife.
b. This payment:
1. has already been made.
2. shall be made in a lump sum payment no later than (date) .
3. shall be paid in the amount of $ per month beginning
on the first day of the month of , 20 .
c. The amount shall earn interest until paid in full at the rate of % per year:
1. from the date of the final hearing.
2. from the date the payment was due.
H. TAXES
1. Year of Divorce/Legal Separation:
The parties agree to file their income tax returns for the year of the divorce/legal
separation consistent with the rules of the IRS, Wisconsin Department of Revenue, and
Wisconsin’s Marital Property law.
The parties understand that their marital status on the last day of the year determines
their filing status for that year, whether married or single.
The parties acknowledge that each is responsible for seeking tax advice from a tax
professional with regard to issues of this divorce/legal separation.
2. Years Before Divorce/Legal Separation:
a. Tax returns for all previous years have been filed.
b. The parties agree to file returns for the previous tax years as follows:
1. share preparation expenses, tax liability and/or refund equally.
2. Other:
I. LEGAL NAME RESTORATION
1. Neither party requests the right to use a former legal surname.
2. The wife requests the right to use a former legal surname of
3. The husband requests the right to use a former legal surname of
Note: If this is an action for legal separation, the court cannot allow a spouse to resume a former legal
surname unless and until the judgment is converted to a divorce.
J. OTHER PROPOSED 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 that:
I could get an attorney to review this proposed agreement.
This form was provided as a convenience and may NOT cover all issues.
These proposed agreements 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.
FA-4153V, 01/09 Proposed Marital Settlement Without Minor Children §767.34, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 5 of 7Check 1, 2, or 3.
If 2 or 3, enter the
former legal surname.
Check 1 or 2.
If 2, attach any
additional agreements.If 1, check a or b.
If 2, enter the amount.
In a, check 1 or 2.
In b, check 1, 2 or 3.
If 2, enter the date
[month, day, year].
If 3, enter the amount
and date.
In c, enter the
percentage and check 1
or 2.
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).
Proposed Marital Settlement Without Minor Children Page 6 of 7 Case No. Error: Reference source not found __________
There are certain legal presumptions under Wisconsin law, such as marital property
should be divided 50/50.
L. VOLUNTARY EXECUTION / NATURE OF PROPOSED AGREEMENT
I assume responsibility for the entire content of this proposed agreement. I have proposed
these agreements 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 hereafter, sue the other, personal representatives, and assigns, for the purpose of
enforcing any or 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 proposed agreement represents all the property in which either
party has any interest. This proposed agreement 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 proposed agreement.
Q. DIVESTING OF PROPERTY RIGHTS
Except as otherwise provided for in this proposed agreement, the parties give up all rights to
the property awarded to the other.
All property awarded to a party shall be the separate property of that party.
The parties shall have the right to manage our separate property as if we had never been married.
R. SURVIVAL OF PROPOSED AGREEMENT AFTER JUDGMENT
The provisions of this proposed agreement shall survive any subsequent judgment of
divorce and shall have independent legal significance. This proposed agreement is a legally
binding contract, entered into for good and valuable consideration. It is contemplated that in
the future either party may enforce this proposed agreement in this or any other court of
competent jurisdiction.
S. JURISDICTION
This county shall have jurisdiction for all disputes unless otherwise agreed to in writing or as
provided under Wisconsin Statutes.
T. APPROVAL OF COURT REQUIRED
FA-4153V, 01/09 Proposed Marital Settlement Without Minor Children §767.34, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 6 of 7
Proposed Marital Settlement Without Minor Children Page 7 of 7 Case No. Error: Reference source not found __________
I submit this proposed agreement 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 proposed agreement 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.
u
Signature
Print or Type Name
If the other party does
later agree with your
proposal you may have
him/her sign and print
his/her name.
Note: This signature
does not need to be
notarized. u
Signature
Print or Type Name
Date
Date
FA-4153V, 01/09 Proposed Marital Settlement Without Minor Children §767.34, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 7 of 7The party who is
proposing the above
agreements must sign
Enter the date on
which he/she signed.
Note: This signature
does not need to be
notarized.
PRINT in INK
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. The real estate shall be awarded to the:
a. wife
b. husband
and that party shall be responsible for outstanding financial obligations, and the other party shall be
held harmless from any liability. Other provisions including refinancing requirements, if any:
See attached
2. The residence shall be placed on the market for sale.
a. Pending sale, the mortgage, taxes, and insurance shall be paid by:
1. wife.
2. husband.
3. shared equally.
4. shared as follows:
b. Pending sale, any necessary repairs, special assessments and other sale-related expenses shall be
paid by:
1. wife.
2. husband.
3. shared equally.
4. shared as follows:
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. The wife to receive %.
b. The husband 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. The real estate shall be awarded to the:
a. wife
b. husband
and that party shall be responsible for outstanding financial obligations, and the other party shall be held
harmless from any liability. Other provisions including refinancing requirements, if any:
See attached
2. The residence shall be placed on the market for sale.
a. Pending sale, the mortgage, taxes, and insurance shall be paid by:
1. wife.
2. husband.
3. shared equally.
4. shared as follows:
b. Pending sale, any necessary repairs, special assessments and other sale-related expenses shall
be paid by:
1. wife.
2. husband.
3. shared equally.
4. shared as follows:
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:
FA-4153V, 01/09 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 1
Proposed Marital Settlement Without Minor Children Page 2 of 7 Case No. __________
a. The wife to receive %.
b. The husband to receive %.
FA-4153V, 01/09 Proposed Marital Settlement Without Minor Children §767.34, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 2 of 7