Fill and Sign the Wisconsin Order Legal Form

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 Stipulation and Order Dismissing Divorce/Legal Separation 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 Enter the case number. STIPULATION IT IS STIPULATED THAT : 1. The above parties have reconciled. 2. This action may be dismissed without further costs to either of the parties. 3. An order may be entered without notice to either of the parties. 4. Any income assignment shall end when the state has been paid in full. The state reserves the right to collect on any debts owed to it. 5. Warrants: A. There are no outstanding warrants to arrest issued in this action. B. There are outstanding warrants to arrest issued in this action . Explain:       Note to the parties: This stipulation does not affect any domestic abuse, harassment, or child abuse injunctions under §813, Wisconsin Statutes currently in effect. The wife must sign and print her name. Enter the date on which the wife signed. Note: This signature does not need to be notarized. u Signature of Wife       Print or Type Name       Date FA-4143V, 01/09 Stipulation and Order Dismissing Divorce/Legal Separation §§767.323 and 807.05 Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2Check A or B. If B, describe the warrant that has been issued in this case. Stipulation and Order Dismissing Divorce/Legal Separation Page 2 of 2 Case No. Error: Reference source not found _______________ The husband must sign and print his name. Enter the date on which the husband signed. Note: This signature does not need to be notarized. u Signature of Husband       Print or Type Name       Date State of Wisconsin, Child Support Agency If either party is receiving public assistance or there is a caseworker from the Child Support Agency assigned to your case, you must take this agreement to the Child Support Agency in your county for their approval. If not, mark not required. Approved Not Approved Not Required Authorized Signature       Print or Type Name       Title       Date ORDER IT IS ORDERED , that this action is dismissed without further costs to either of the parties. THIS IS A FINAL ORDER FOR PURPOSES OF APPEAL. BY THE COURT: For Court Use Only.       Circuit Court Judge/Circuit Court Commissioner       Print or Type Name       Date FA-4143V, 01/09 Stipulation and Order Dismissing Divorce/Legal Separation §§767.323 and 807.05 Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2