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Wisconsin Separation Agreement Template

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Wisconsin Separation Agreement Template
Wisconsin Separation Agreement Template
FA-4150V, 02/10 Marital Settlement Agreement - With Minor Children ยง767.34, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 1 of 11 - -
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
Marital Settlement
Agreement
With Minor Children
Divorce-40101
Legal Separation-40201
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
Check divorce or legal
separation.
Enter the case number.
Warning: Subject to court approval, the terms of this agreement will be included in your judgment of divorce or legal
separation. Be sure you understand it completely. Some portions of this agreement cannot be changed after the
court approves it, even if you did not understand or expect how it would affect you. You may wish to speak with a
lawyer before you sign this agreement to be sure you are fully aware of the laws that may apply to you.
WE AGREE AS FOLLOWS:
A. MARITAL RELATIONSHIP
1. Divorce. This marriage is irretrievably broken.
2. Legal Separation. This marriage is broken and the reason we are requesting a legal
separation and not a divorce is
B. MAINTENANCE (Spousal Support)
1. For the Wife:
a. The wife gives up her right to receive maintenance. She understands that by
giving up maintenance at this time, she may never ask for maintenance.
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
1. the following circumstance(s) only:
2. any appropriate substantial change in circumstance.
c. The husband shall pay maintenance to the wife in the amount of $ per month
beginning , 20 . Maintenance shall end ,
20 , or until the wife remarries, dies, or by court order, whichever comes first.
2. For the Husband:
a. The husband gives up his right to receive maintenance. He understands that by
giving up maintenance at this time, he may never ask for maintenance.
b. The husband is not requesting maintenance at this time, but leaves open his right to
request it until . His right to request maintenance is limited to
1. the following circumstance(s) only:
2. any appropriate substantial change in circumstance.
c. The wife shall pay maintenance to the husband in the amount of $ per month
beginning , 20 . Maintenance shall end ,
20 , or until the husband remarries, dies, or by court order, whichever comes first.
In A, check 1 or 2.
If 2, enter the reason you
are asking for a legal
separation and not a
divorce.
In B.1, check a, b, or c.
If b, enter a date and
choose 1 or 2.
If 1, enter the reasons.
If c, enter the
maintenance amount and
the date the payments
should begin and end.
In 2, check a, b, or c.
If b, enter a date and
choose 1 or 2.
If 1, enter the reasons.
If c, enter the
maintenance amount and
the date the payments
should begin and end.
Wisconsin Separation Agreement Template
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