PRINT in INK
Enter the name of the
county in which you are
filing this case. STATE OF WISCONSIN, CIRCUIT COURT,
COUNTY For Official Use
Enter your name (you are
the petitioner ). In RE: The marriage of
Petitioner :
First name Middle name Last name
Address
Address
City State Zip
andEnter your address.
On the far right, check
divorce or legal
separation.
Petition
With Minor Children
D ivorce-40101
Legal Separation-40201
Case No. Enter your spouse’s name
(your spouse is the
respondent) . Respondent :
First name Middle name Last name
Address
Address
City State ZipEnter your spouse’s
address.
Note: Leave case number
blank; the clerk will add
this.
I am the petitioner in this action.
A. I am providing the following information about myself:
1. Date of birth
2. Immediately before filing this petition, I will have lived in this county for 30 days or more.
Yes No
3. Immediately before filing this petition, I will have lived in the state of Wisconsin for 6
months or more.
Yes No
4. I am currently on active duty as a member of the Armed Forces of the United States of
America or its allies.
Yes No
B. I am providing the following information about the respondent, my spouse:
1. Date of birth
2. Immediately before filing this petition, the respondent will have lived in this
county for 30 days or more.
Yes No
3. Immediately before filing this petition, the respondent will have lived in the state
of Wisconsin for 6 months or more.
Yes No
FA-4108V, 01/09 Petition-With Minor Children §§767.215 and 822.29, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 1 of 7Enter your date of birth
[month, day, year].
For 2, 3 and 4, check
yes or no.
Military personnel:
Please see Basic Guide
to Divorce/Legal
Separation.
Enter your spouse’s
date of birth [month, day,
year].
For 2, 3 and 4, check yes
or no.
Military personnel:
Please see Basic Guide to
Divorce/Legal
Separation.
Petition – With Minor Children Page 2 of 8 Case No. Error: Reference source not
found _______________
4. The respondent is currently on active duty as a member of the Armed Forces of
the United States of America or its allies.
Yes No
C. I am providing the following marriage information:
1. My spouse and I were married on (date)
2. We were married in (city) (state)
3. I am filing for:
a. Divorce: This marriage is irretrievably broken.
b. Legal Separation : This marriage is broken and the reason I am requesting a
legal separation and not a divorce is
4. Previous Actions
This is the first time that either my spouse or I have filed for divorce or legal separation
from each other in Wisconsin or in any other state:
a. Yes
b. No: County
State
Case No.
Has this case been dismissed? Yes No
5. This is my first marriage.
Yes No
a . I 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
e . I 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 you had more than 2 previous marriages, repeat 5e-5h on an additional sheet.
6. This is my spouse’s first marriage.
Yes No
a. My spouse 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
e. My spouse was also previously married to
f. The marriage was terminated by: divorce. death.
FA-4108V, 01/09 Petition-With Minor Children §§767.215 and 822.29, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 2 of 8Enter the date [month,
day, year], city, and state
in which you were
married.
Check yes or no. If no,
respond to 5a-5d with
information about your
most recent previous
marriage.
If you had an additional
previous marriage,
respond to 5e-5h.
Check yes or no. If no,
respond to 6a-6d with
information about your
spouse’s most recent
previous marriage, if
known.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.
If your spouse had an
additional previous
marriage, respond to
6e-6h.Check a or b. If b,
explain why you are
filing for a legal
separation and not a
divorce.
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found _______________
g. Date of the divorce or death
h. The divorce was granted in:
Name of court
City State
If your spouse had more than 2 previous marriages, repeat 6e-6h on an additional sheet.
D. I am providing the following information regarding children:
1. The minor children (age 17 or younger) born to or adopted together by me and my
spouse before or during our marriage are:
None
Name of Child Date of Birth
2. The adult children (age 18 or older) born to or adopted together by me and my spouse
before or during our marriage are:
None
Name of Child Date of Birth
3. Other children born to the wife during this marriage, but not fathered by the husband are:
None
Name of Child Date of Birth
4. To the best of my knowledge, the wife in this marriage:
a. is currently pregnant. (An attorney [guardian ad litem] for the unborn child will be
required if the husband is not the father.)
b. is not currently pregnant.
5. The current address of the minor children is:
a. with mother at above address.
b. with father at the above address.
c. with both mother and father at the above addresses.
d. at the address below:
Address
Address
City State Zip
6. Previous addresses for the minor children are:
None (the children have lived at the current address for the last five years).
Address
Address
FA-4108V, 01/09 Petition-With Minor Children §§767.215 and 822.29, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 3 of 8Check a, b, c or d.
If d, enter the current
address of the minor
children. If the children
currently reside at
separate addresses,
provide those addresses
on an additional sheet.
Enter any previous
addresses for the minor
children living with the
parents during the past 5
years. If none check
“none.”
If the children have lived
in more than 2 places
over the past 5 years,
provide those addresses
on an additional sheet. Enter the name and date
of birth [month, day,
year] for each minor
child. If you and your
spouse do not have
minor children together,
check None.
Petition – With Minor Children Page 4 of 8 Case No. Error: Reference source not
found _______________
City State Zip
Address
Address
City State Zip
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
Child
Person
Address
Address
City State Zip
Child
Person
Address
Address
City State Zip
Child
Person
Address
Address
City State Zip
8. I personally have been (or I am 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.
a. Yes and the custody, physical placement, or visitation order was granted in:
Name of court
Case Number Date
b. No
9. I am 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.
a. Yes, and the proceeding that could affect the current proceeding is in:
Name of court
Case Number
Nature of Proceeding
b. No
FA-4108V, 01/09 Petition-With Minor Children §§767.215 and 822.29, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 4 of 8Check yes or no.
If yes, enter the name of
that minor child and the
name and address of the
person with whom that
child lived.
Attach an additional
sheet, if necessary.
Check a or b.
If a, enter the name of
the court in which it was
ordered, the case
number assigned to it,
and date it was ordered.
Check a or b.
If a, enter the name of
the court, the case
number assigned to it,
and the nature of the
proceeding.
Petition – With Minor Children Page 5 of 8 Case No. Error: Reference source not
found _______________
10. My spouse and I 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 I have attached a copy of the written agreement to this Petition.
b. No
I ASK THAT THE COURT:
1. Grant a judgment as requested.
2. Enter an order granting maintenance.
Yes No
3. Enter other orders as it deems just and equitable.
ACTS PROHIBITED BY STATUTE
In accordance with §767.117, Wis. Stats., neither the petitioner nor the respondent 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 restraint 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 or the Circuit Court Commissioner, 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 state of Wisconsin or more than
150 miles from the residence of the other party within the state without the consent of the other party or
an order of the court or Circuit Court Commissioner.
4. Removing a minor child of the parties from the state of Wisconsin for more than 90 consecutive days
without the consent of the other party or an order of the court or Circuit Court Commissioner.
5. Concealing a minor child of the parties from the other party without the consent of the other party or
an order of the court or Circuit Court Commissioner.
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 SEC. 785.04 WIS. STATS.
A violation of paragraphs 3, 4, or 5 above is not a contempt of court if the court finds that the action
was taken to protect a party or a minor child of the parties from physical abuse by 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 the action is entered, or
the court orders otherwise.
STOP!
Take this document to a Notary Public BEFORE you sign it.
FA-4108V, 01/09 Petition-With Minor Children §§767.215 and 822.29, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 5 of 8Check a or b. If a, attach
a copy of the written
agreement.
If you are requesting
maintenance (spousal
support) at this time,
check yes. If not, check
no.
Petition – With Minor Children Page 6 of 8 Case No. Error: Reference source not
found _______________
After you have been
sworn by a Notary
Public, sign and print
your name and date
the document in front
of the Notary Public. u
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
My commission expires: (Seal)
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 percentage 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
payer 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 child
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
taxed 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
FA-4108V, 01/09 Petition-With Minor Children §§767.215 and 822.29, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 6 of 8
Petition – With Minor Children Page 7 of 8 Case No. Error: Reference source not
found _______________
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 Statute
767 Actions Affecting the Family. (Choose “Wisconsin Law” on http://www.legis.state.wi.us )
FA-4108V, 01/09 Petition-With Minor Children §§767.215 and 822.29, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 7 of 8
Petition – With Minor Children Page 8 of 8 Case No. Error: Reference source not
found _______________
Statutory Factors Courts May Consider In Determining Child Support Awards for
Paternity, Divorce, or Legal Separation
§767.511, Child Support .
(1 m) 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
greater weight of the credible evidence that use of the percentage standard is unfair to the child or to
any of the parties:
(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 marriage
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 placement
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.
FA-4108V, 01/09 Petition-With Minor Children §§767.215 and 822.29, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 8 of 8