Form : P1 - Wisconsin Summons, Petition Forms Page 2
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2STATE OF WISCONSIN : CIRCUIT COURT : _____________ COUNTY
FAMILY COURT BRANCH
IN RE THE CUSTODY AND SUPPORT OF:________________________________________________
______________________________
PETITIONER
CASE NO.:
-AND-
CODE NO.:
40402
______________________________
RESPONDENT
PETITION UNDER SEC. 767.805, WIS. STATS.
_____________________________ states as follows:
1.That ______________________ was born on_______________ in the city of _________________________________.
2. That _______________________ is the mother and __________________________is the father.
_________________________is not not currently residing with the child. _________________has a duty to support child.
Upon information and belief, no parental custody plan exists and no other custody action is pending here or elsewhere.
3. The parties filed the blue acknowledgment of paternity form with the Center for Health Statistics.
4. Upon information and belief, the blue acknowledgment of paternity form has not been rescinded by either party.
The father is presumed to be the parent of the child.
WHEREFORE, ______________________________, petitions this court for:
a. An order consistent with secs. 767.805 and 767.89, Wis. Stats.
b. __ Past __ future child support, __ day care expenses, __ bills and __ service costs related to pregnancy.
c. __ An income assignment.
d. __ Sole __ Joint custody and primary physical placement to ________________ and reasonable periodic or structured
placement with ________________________at reasonable times upon notice and upon a proposed structured schedule.
e. __ Attorney fees, court costs, and service fees to be paid for by _________________________.
f. Any such other orders as are fair and equitable.
Dated in the city of: _____________________________ , state of Wisconsin on Month: __________________ Day: __________ Year 20______.
By:___________________________________________
Petitioner's Signature
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