Form Fa-4150v - Marital Settlement Agreement - Wisconsin Circuit Court Page 2
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11Marital Settlement Agreement With Minor Children
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Case No.
_____________
3. Payments shall be made:
Enter a or b.
a.
No payments are ordered to be made.
b.
to the Wisconsin Support Collections Trust Fund (WI SCTF) at Box 74200,
If b, check 1 or 2. If 2,
Milwaukee, Wisconsin 53274-0200:
enter the employer
1.
directly from the payer to WI SCTF
(only allowable if self-employed).
information.
2.
by income assignment from the payer’s employer as indicated below:
Employer name
Address of payroll office
City
State
Zip
Phone
Fax
4. Arrearages for Previously Ordered Maintenance: The amount of the maintenance
Note: An arrearage is an
arrears owed to a party shall be paid as follows:
a.
No maintenance was previously ordered. There is no amount due.
amount ordered that has
not been paid and is
b.
The party has paid all maintenance as ordered. There is no amount due.
overdue.
c.
If there are any arrearages for maintenance now or at the time of the final hearing,
Check a, b, c or d.
those arrearages are waived and the court financial record shall be set to zero.
If d, check 1or 2. If 1,
d.
The parties agree that the amount of the arrears:
1.
shall be set as follows: $
enter arrearage amount.
2.
shall be determined by the court at the time of the final hearing
If 2, enter the interest
rate and check A or B. If
and shall be paid and earn interest at the rate of
% per year and
A, enter the date. If B,
payment shall be as:
enter the amount of the
A.
a one-time payment to the WI SCTF made by
.
(date)
monthly payment and the
B.
through monthly income withholding by the WI SCTF in the amount of
$
beginning on the first day of the
month and year the
payments shall begin.
month of
, 20
until the arrearages are paid in full.
C. MEDICAL INSURANCE
No later than the date of the final hearing, each party shall notify the other party in writing of
For each debt owed
the availability of COBRA or other continuation benefits under their current health care policy.
individually or jointly,
write the name, current
D. DEBTS AND LIABILITIES
balance, and check who
The following is a listing of ALL the debts and liabilities that we presently owe (either individually
will be responsible for
or as a couple) and who we agree shall be responsible for the payment of each debt:
payment.
To be Paid
To be Paid
Creditor’s Name
Balance
by Wife
by Husband
Note: Any and all debts
$
disclosed on the parties’
$
Financial Disclosure
$
Statements that are still
$
unpaid should be
$
included here and
divided between the
$
parties. Any new debts
$
incurred should also be
$
listed and divided.
$
$
If more space is
$
necessary, attach
additional sheets.
$
$
The parties agree and understand that:
•
Each party assigned a debt shall be fully responsible for that obligation and shall not
make any demands upon the other party concerning that debt.
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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