Fill and Sign the Publication Affidavit of Mailing Wisconsin Form

PRINT in BLACK ink Enter the name of the county in which this case is filed. STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use Enter your name. In re the marriage of: Petitioner:       First name Middle name Last name andOn the far right, check divorce or legal separation. Publication Affidavit of Mailing D ivorce-40101 Legal Separation-40201 Case No.       Enter your spouse’s name. Respondent:       First name Middle name Last nameEnter the case number. Under oath I state that 1. The respondent is being served the authenticated Summons and Petition by publication. A separate affidavit of publication from the publisher/printer will be filed with the court. 2. In order to comply with statutory requirements for publication, I have also placed in an envelope a copy of the authenticated Summons and Petition. 3. I mailed that envelope with proper postage affixed on (date)       to: Name       Address       Address       City       State       Zip       STOP! Take this document to a Notary Public BEFORE you sign it. After you have been sworn by a Notary Public, sign and print your name and date the document in front of the Notary Public. Signature       Print or Type Name       Date Have the Notary Public sign, date, and seal the document. Subscribed and sworn to before me on       Notary Public, State of Wisconsin (Seal) FA-4123 Pro Se, 01/06 Publication Affidavit of Mailing §801.10, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2Enter the date [month, day, year] on which you placed the documents in a mailbox, and the name and last known address of the respondent. My commission expires:       FA-4121, 2/13/05 Affidavit of Mailing Wisconsin Statutes §985 Page 2 of 2