Fill and Sign the Wisconsin Child Support Form

PRINT in BLACK ink Enter the name of the county in which the original case was filed. STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use Check marriage or paternity. If paternity, enter initials of child. In RE: The marriage paternity of       Petitioner/Joint Petitioner :       First name Middle name Last name       Current Mailing Address       City State Zip Daytime Phone Number vs.Enter the name, address and daytime phone number of the petitioner or joint petitioner from the original case file. On the far right, mark the box for the change(s) you are requesting and enter the original case number. Notice of Motion and Motion to Change: Legal Custody Physical Placement Child Support Maintenance Other:       Case No.       Enter the name, address, and daytime phone number of the respondent or joint petitioner from the original case file. Respondent/Joint Petitioner :       First name Middle name Last name       Current Mailing Address       City State Zip Daytime Phone Number The State of Wisconsin (Child Support Agency) is is not a party to this action.Check if the State of Wisconsin is a party or not. If you are unsure, you may call your local Child Support Agency. NOTICE OF MOTION TO       You are notified that at the following date and time: Before       Location             Date       Time       a.m./p.m. , or as soon as the matter may be heard. I will be asking the court to change the existing order in this case as indicated below. If you object to this motion, you need to appear and say so. Otherwise, the court may proceed without you and grant the request. FA-4170V, 01/09 Notice of Motion and Motion to Change: Support/Legal Custody/Physical Placement §§767.105, 767.451, and 767.59, Wisconsin Statutes This form shall not be modified, It may be supplemented with additional material. Page 1 of 3For Court Use Only: This section will be completed by the court. Enter the name of the person to whom this motion is directed. Notice of Motion and Motion to Change: Support/Legal Custody/Physical Placement Page 2 of 3 Case No. Error: Reference source not found __________ You may contact the Circuit Court Commissioner for more information on modifying and enforcing court orders or judgments. MOTION 1 . I am requesting that the court: A. change the existing legal custody or physical placement of the following children:       1. to joint legal custody with both parents. 2. to sole legal custody with me. 3. from primary physical placement with (name of parent) :       to (name of parent)       4. from shared placement to primary placement with (name of parent)       . 5. from the current placement schedule (if any) to a new schedule I have attached . 6. to require placement be supervised. unsupervised. T he other party and I: attempted mediation on (date)       . have not attempted mediation for this issue. B. change the following support orders as follows: 1. Child support that is currently $       per       to: a. a new amount based on state child support standards determined by the court. b. a new set amount of $       per       . c. held open as of (date)       . d. payments to be made by (name of parent)       . 2. Maintenance (spousal support) that is currently $       per       to: a. an amount to be determined by the court based on current income. b. a new set amount of $       per       . 3 . Arrears payment that is currently $       per       to: a. an amount to be determined by the court. b. a new set amount of $       per       . 4 . Arrears balance as it is currently reflected in the WI SCTF KIDS computer system as $       to $       because: a. I have made support or other payments directly to the other party. b. I dispute the amount that is currently on record. I will be able to provide documentation to the court that supports my request. NOTICE: B oth parties must bring to court their fully completed, dated, and signed Income and Expense Statement and all required attachments. C. Other change(s):       See attached 2. The court order that I am asking to be modified was dated:       . 3. This request is based on the following substantial change in circumstances that have occurred since the entry of the prior court order in this case. A. A child who was living with the other parent is now living with me. B. A child is no longer eligible for child support because the child has reached age 18, or is over 18 but under 19, and is no longer pursuing a course of education leading to a high school diploma or its equivalent. C. One of the parties has or will be moving to a different residence. D. There is not a placement schedule and the parties cannot agree. E. Employment or work shift of       has changed. both parties has changed . FA-4170V, 01/09 Notice of Motion and Motion to Change: Support/Legal Custody/Physical Placement §§767.105, 767.451, and 767.59, Wisconsin Statutes This form shall not be modified, It may be supplemented with additional material. Page 2 of 3If you are requesting any changes to legal custody or physical placement, check A , enter the names of the children involved, and check all that apply in 1-6. Complete all relevant information, and attach a copy of your proposed placement schedule, if applicable. Indicate if you have or have not attempted Mediation. If you have, indicate the date of the Mediation session. If you are requesting any changes related to a support order, check B, check all that apply in 1- 4 , and complete all relevant information for each section checked. In C, enter any other changes you may have. Check all that apply in A- H. If E or F, enter the party’s information that has changed. If other, enter the change in circumstance that has prompted you to bring this Motion.Enter the date the current court order or judgment was signed by a court official. Notice of Motion and Motion to Change: Support/Legal Custody/Physical Placement Page 3 of 3 Case No. Error: Reference source not found __________ F. Income or wages of       has changed. both parties has changed . G. The party to whom maintenance is owed has remarried. H. Other:       4. The facts explaining the substantial change in circumstances or deviation in child support percentage standard are:       See attached If you require reasonable accommodations due to a disability, in order to participate in the court process, please call:       at least ten (10) working days prior to the scheduled court date. Please note that the court does not provide transportation. Sign and print your name. Enter the date on which you signed your name. Note: This signature does not need to be notarized. u Signature       Print or Type Name       Date A copy of this Notice of Motion and Motion must be served upon all other parties at least 5 business days before the date of the hearing. If service is by mail, it must be mailed at least 8 business days before the date of the hearing. See the Service Packet for more information. FA-4170V, 01/09 Notice of Motion and Motion to Change: Support/Legal Custody/Physical Placement §§767.105, 767.451, and 767.59, Wisconsin Statutes This form shall not be modified, It may be supplemented with additional material. Page 3 of 3In 4, d escribe the facts that justify the change you want. Attach additional pages, if necessary.