Fill and Sign the Was Filed by Your Spouse Form

FA-4113V, 03/12 Response and Counterclaim §§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 2 Enter the name of the county in which this case was filed by your spouse. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Enter your spouse’s name (he/she is the petitioner). IN RE : THE MARRIAGE OF Petitioner Name (First, Middle and Last) and On the far right, check if your spouse filed for divorce or legal separation. Response and Counterclaim Divorce-40101 Legal Separation-40201 Case No. Enter your name (you are the respondent). Respondent Name (First, Middle and Last) Enter the case number. RESPONSE I am the respondent in this action. Read through section A, section B, section C, and section D of the Petition. A. I accept all the statements made in section A of the Petition to be true and correct. Yes No If all the statements are true, check yes in the appropriate section. I am making the following changes: If any statement or fact is untrue or incorrect, check no in the appropriate section and enter the correct information on the lines. B. I accept all the statements made in section B of the Petition to be true and correct. Yes No I am making the following changes: C. I accept all the statements made in section C of the Petition to be true and correct. Yes No I am making the following changes: D. I accept all the statements made in section D of the Petition to be true and correct. Yes No I am making the following changes: COUNTERCLAIM Check all boxes that apply. I REQUEST THE FOLLOWING RELIEF FROM THE COURT: A. A judgment of 1. Divorce. This marriage is irretrievably broken. If 2, explain why you are requesting a legal 2. Legal Separation . This marriage is broken and the reason I am requesting a legal separation and not a divorce is Response and Counterclaim Page 2 of 2 Case No. ________ FA-4113V, 03/12 Response and Counterclaim §§76 7.215 and 822.29, W isconsin Statutes This form shall not be modified. It may be supplemented with additional mat erial. Page 2 of 2 separation and not a divorce. 3. Other: 4. Dismissal of this action. B. Enter other orders as it deems just and equitable. STOP! If you have minor children, 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. If you do not have minor children, sign, print your name and date. A Notary is not required. ► Signature Print or Type Name Address 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)