Form Fa-4150v - Marital Settlement Agreement - Wisconsin Circuit Court
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11PRINT in INK
Enter the name of the
For Official Use
STATE OF WISCONSIN, CIRCUIT COURT,
county in which this case
COUNTY
is filed.
Enter the name of the
In RE: The marriage of
petitioner. If joint
Petitioner/Joint Petitioner-Wife:
petitioners, enter the name
of the wife.
First name
Middle name
Last name
and
Marital Settlement
Agreement
Respondent/Joint Petitioner-Husband:
Enter the name of the
With Minor Children
respondent. If joint
petitioners, enter the name
Divorce-40101
of the husband.
First name
Middle name
Last name
Legal Separation-40201
Check divorce or legal
separation.
Case No.
Enter the case number.
Check 1 or 2.
WE AGREE AS FOLLOWS:
If 2, enter the reason you
A. MARITAL RELATIONSHIP
are asking for a legal
1.
Divorce: This marriage is irretrievably broken.
separation and not a
divorce.
2.
Legal Separation: This marriage is broken and the reason we are requesting a legal
separation and not a divorce is:
Check a, b, or c.
B. MAINTENANCE
(Spousal Support)
1. For the Wife:
If b, enter a date and
a.
The wife gives up her right to receive maintenance. She understands that by giving up
choose 1 or 2.
maintenance at this time, she may never ask for maintenance.
If 1, enter the reasons.
b.
The wife is not requesting maintenance at this time, but leaves open her right to request it
until
. Her right to request maintenance is limited to:
If c, enter the
1.
the following circumstance(s) only:
maintenance amount and
2.
any appropriate substantial change in circumstance.
the month and year the
c.
The husband shall pay maintenance to the wife in the amount of $
per month
payments should begin
beginning on the first day of the month of
, 20
.
and end.
Maintenance shall end on the last day of the month of
20
,
or until the wife remarries, dies, or by court order, whichever comes first.
Check a, b, or c.
If b, enter a date and
2. For the Husband:
choose 1 or 2.
a.
The husband gives up his right to receive maintenance. He understands that by giving
If 1, enter the reasons.
up maintenance at this time, he may never ask for maintenance.
If c, enter the
b.
The husband is not requesting maintenance at this time, but leaves open his right to
maintenance amount and
request it until
. His right to request maintenance is limited to:
the month and year the
1.
the following circumstance(s) only:
payments should begin
2.
any appropriate substantial change in circumstance.
and end.
c.
The wife shall pay maintenance to the husband in the amount of $
per month
beginning on the first day of the month of
20
.
Maintenance shall end on the last day of the month of
, 20
, or
until the husband remarries, dies, or by court order, whichever comes first.
FA-4150V, 01/09 Marital Settlement Agreement With Minor Children
§767.34, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
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