Fill and Sign the Wisconsin Support Form

PRINT in 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       Enter the name, address, and daytime phone number of the petitioner or joint petitioner from the original case file. Petitioner/Joint Petitioner :       First name Middle name Last name       Current Mailing Address       City State Zip Daytime phone number vs.On the far right, mark the box for the change(s) you requested and enter the original case number. Decision & Order on Motion or Order To Show Cause 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 Check if the State of Wisconsin is a party or not. If you are unsure, you may call your local Child Support Agency. The State of Wisconsin (Child Support Agency) is is not a party to this action. DECISION AND ORDER ON MOTION or ORDER TO SHOW CAUSE HEARING A hearing was conducted in this matter as follows: 1. Before       Circuit Court Judge/Circuit Court Commissioner 2 . Location             3. Date       APPEARANCES 1. Former Wife/Mother: appeared in person appeared by phone did not appear AND A. was self-represented. B. was represented by Attorney       . 2. Former Husband/Father : appeared in person appeared by phone did not appear AND A. was self-represented. B. was represented by Attorney       . 3. Others appearing at the hearing: A. None. FA-4175V, 01/09 Decision & Order on Motion or Order to Show Cause to Change: Legal Custody/ §§767.451 and 767.59, Wisconsin Statutes Physical Custody/Child Support/Maintenance/Other This form shall not be modified, It may be supplemented with additional material. Page 1 of 4Enter the name of the court official who held the hearing and the address and date [month, day, year] on which it was held. Check one box from 1 and check A or B . If B , enter the name of the attorney. Check one box from 2 and check A or B . If B , enter the name of the attorney. Check A, B, C , or D . If B, C, or D , enter the name of the individual who appeared. STOP! Do not complete the remainder of this form unless required by the court official who is hearing this case. Decision & Order on Motion or Order to Show Cause to Change Page 2 of 4 Case No. Error: Reference source not found ____________ B. Child Support Agency by       . C. Guardian ad Litem (GAL)       . D. Other:       . FINDINGS and ORDER: Based on the findings and reasons stated, IT IS ORDERED: 1. The Motion or Order to Show Cause is : A. DENIED because no substantial change in circumstance was found. The current order remains in effect. B. DEFERRED to collect more information. Before making a final decision the court orders the following: 1. The parties attend mediation with       a. no payment is required. b. wife/mother to pay $       towards the mediation fee by       . c. husband/father to pay $       towards the mediation fee by       . 2. Attorney       be appointed as GAL and: a. no payment is required. b. wife/mother to pay $       towards the GAL fee by       . c. husband/father to pay $       towards the GAL fee by       . 3. A physical placement study be conducted by       . a. no payment is required. b. wife/mother to pay $       towards the study fee by:       . c. husband/father to pay $       towards the study fee by:       . 4. Other :       C. GRANTED as follows : 1. The legal custody or physical placement of the following children :       is changed: a. to joint legal custody with both parents. b. to sole legal custody with (name of parent)       . c. from primary physical placement with (name of parent)       to (name of parent)       . d. from shared placement to primary placement with (name of parent) e. to require placement be: supervised unsupervised as follows :       f. according to the attached placement schedule. g. Other:       2. Change the financial orders as follows: a. Child support held open to $       per       beginning on the first day of the month of       Payments shall be made by (name of parent)       b. Maintenance (spousal support) to $       per       beginning on the first day of the month of       . c. Arrears payment to $       per       beginning on the first day of the month of       . d. Arrears balance is set in the WI SCTF KIDS computer system at $       as of the first day of the month of       . FA-4175V, 01/09 Decision & Order on Motion or Order to Show Cause to Change: Legal Custody/ §§767.451 and 767.59, Wisconsin Statutes Physical Custody/Child Support/Maintenance/Other This form shall not be modified, It may be supplemented with additional material. Page 2 of 4Check A, B, or C. Check B, if the judge ordered the parties to do certain things before he/she makes a decision. If B, check all that apply and complete the corresponding information as necessary. Check C, if the judge ordered changes to the current court order. If C, check all that apply in 1-4, and complete the corresponding information as was ordered by the court. Check A if the court denied the request to change the order. Decision & Order on Motion or Order to Show Cause to Change Page 3 of 4 Case No. Error: Reference source not found ____________ e. Arrears Interest is set in the WI SCTF KIDS computer system at $       as of the first day of the month of       . Payments shall be made: 1. No payments are ordered to be made. 2. to the Wisconsin Support Collections Trust Fund (WI SCTF) at Box 74200, Milwaukee, Wisconsin 53274-0200: a. directly from the payer to WI SCTF ( only allowable if self-employed ). b . by income assignment from the payer’s employer as indicated below: Employer name       Address of payroll office       City       State       Zip       Phone       Fax       3. Other financial order(s):       See attached 4. Other non-financial order(s):       See attached 2. A future hearing: A. is NOT required. B. is set for (date)       time       am/pm before       in Room #       . 3. Both parties shall notify the Clerk of Courts and the local Child Support Agency in writing, within 10 business days of any change of address, employment, and of any substantial change in income affecting the ability to pay support. This notification does not change the support order. Any party may file moving papers to change this order. 4. If this matter was heard by a Court Commissioner, and either party requests a new hearing, a Request for New (DeNovo) Hearing must be filed with the Clerk of Courts within the time period established by local court rule. 5. If this matter was heard by a Circuit Court Judge, this is a final judgment/order for purposes of appeal. FAILURE TO OBEY THIS ORDER IS PUNISHABLE AS CONTEMPT OF COURT AND MAY RESULT IN A JAIL SENTENCE. BY THE COURT: For Court Use Only. Circuit Court Judge/Circuit Court Commissioner       Name Printed or Typed       Date FA-4175V, 01/09 Decision & Order on Motion or Order to Show Cause to Change: Legal Custody/ §§767.451 and 767.59, Wisconsin Statutes Physical Custody/Child Support/Maintenance/Other This form shall not be modified, It may be supplemented with additional material. Page 3 of 4Check A or B. If B, enter the date and time of the review hearing, the judge who will preside, and the room number where the hearing will take place.Enter how the court ordered the payments to be made. Decision & Order on Motion or Order to Show Cause to Change Page 4 of 4 Case No. Error: Reference source not found ____________ When you submit this order to the court, you must send copies to the other party(s). The other party(s) has up to 5 business days to object to the accuracy of this order. FA-4175V, 01/09 Decision & Order on Motion or Order to Show Cause to Change: Legal Custody/ §§767.451 and 767.59, Wisconsin Statutes Physical Custody/Child Support/Maintenance/Other This form shall not be modified, It may be supplemented with additional material. Page 4 of 4