Fa 4170V Form PDF Details

When life changes, the agreements and orders that once made sense may no longer serve us well. The FA-4170V form, a crucial document within the legal landscape of Wisconsin, is designed to address this reality for matters concerning legal custody, physical placement, child support, and maintenance. Designed to be filled out in black ink, it requires detailed information about the parties involved, including names, addresses, and phone numbers, rooted in the initial case file context. It presents a structured way to request amendments to existing court orders, whether due to significant changes in living arrangements, child support eligibility, shifts in income or employment, adjustments in health insurance, or other substantial life changes that warrant a reevaluation of prior judgments. By guiding petitioners through a series of checks and written sections, it encompasses a wide array of scenarios—from changes in physical placement of children, adjustments in legal custody, to modifications in support orders, including child support and maintenance. The form emphasizes the importance of mediation, inviting applicants to note any attempts at resolving issues out of court. It also provides space for detailing the factual basis of requested changes, reinforcing the necessity of presenting clear, grounded reasons for modifications. With sections demanding personal declaration and preparation for court proceedings, including the reminder to bring a completed Financial Disclosure Statement, the FA-4170V form serves as a comprehensive tool for initiating legal adjustments, making it a pivotal document for individuals navigating the transitions of life in the context of Wisconsin's family law system.

QuestionAnswer
Form NameFa 4170V Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesfa 4170v, wisconsin notice motion, wisconsin notice motion change, wisconsin fa 4170v

Form Preview Example

PRINT in BLACK ink

 

 

 

 

 

 

 

Enter the name of the

 

STATE OF WISCONSIN, CIRCUIT COURT,

county in which the

 

 

 

 

 

 

COUNTY

original case was filed.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check marriage or

 

In RE: The

marriage

paternity of

 

 

 

paternity. If paternity,

 

 

 

 

 

Petitioner/Joint Petitioner:

 

 

 

 

enter initials of child.

 

 

 

 

 

Enter the name, address

 

 

 

 

 

 

 

 

and daytime phone

 

 

 

 

 

 

First name

Middle name

Last name

number of the petitioner or

 

 

 

 

 

 

 

 

joint petitioner from the

 

 

 

 

 

 

 

 

Current Mailing Address

 

 

 

 

 

original case file.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

On the far right, mark the

 

 

 

 

 

 

 

 

 

City

State

 

Zip

Daytime Phone Number

box for the change(s) you

 

 

 

 

 

 

 

 

 

 

are requesting and enter

 

vs.

 

 

 

 

 

 

the original case number.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Enter the name, address,

 

Respondent/Joint Petitioner:

 

 

 

 

and daytime phone

 

 

 

 

 

 

 

 

number of the respondent

 

 

 

 

 

 

 

 

First name

Middle name

Last name

or joint petitioner from the

 

 

 

 

 

 

 

 

 

original case file.

 

 

 

 

 

 

 

 

Current Mailing Address

 

 

 

 

 

 

 

 

 

 

 

 

Check if the State of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wisconsin is a party or

 

City

State

 

Zip

Daytime Phone Number

 

 

 

 

 

 

 

 

not. If you are unsure,

 

The State of Wisconsin (Child Support Agency)

you may call your local

 

is

 

 

 

 

 

 

Child Support Agency.

 

 

 

 

 

 

 

 

is not a party to this action.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For Official Use

Notice of Motion and

Motion to Change:

Legal Custody

Physical Placement

Child Support

Maintenance

Other:

Case No.

Enter the name of the person to whom this motion is directed.

NOTICE OF MOTION

TO

For Court Use Only:

This section will be completed by the court.

You are notified that at the following date and time:

Before

Location

Date

Time

 

a.m./p.m., or as soon as the matter may be heard.

I will be asking the court to change the existing order in this case as indicated below.

If you object to this motion, you need to appear and say so. Otherwise, the court may proceed without you and grant the request.

You may contact the Circuit Court Commissioner for more information on modifying and enforcing court orders or judgments.

FA-4170V, 02/10 Notice of Motion and Motion to Change: Custody/Physical Placement/Support/Maintenance

§§767.105, 767.451, and 767.59, Wisconsin Statutes

This form shall not be modified, It may be supplemented with additional material.

Page 1 of 3

to be paid by (Parent)
(Name of Parent)

Notice of Motion and Motion to Change: Custody/Physical Placement/Support/Maintenance Page 2 of 3

Case No.

__________

 

 

 

 

MOTION

Check A if you are requesting a change to physical placement, list the children affected, check 1-4 and/or 5 and/or 6 and complete the necessary information.

Indicate if you have or have not attempted Mediation. If you have, indicate the date of the Mediation session.

1. Modify as follows:

A. Physical Placement Order(s) (time with children) for the following children:

1.

from primary physical placement with (Name of Parent)

 

 

 

to primary placement with (Name of Parent)

 

 

2.

from shared placement to primary placement with (Name of Parent)

 

 

3.

from primary placement to shared placement.

4.

from the current shared placement schedule (if any) to a new shared placement

 

schedule.

 

 

 

 

 

 

 

The requested placement schedule for the changes in 1-4 above is as follows:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

See attached

5.

to require placement with (Name of Parent)

 

 

 

be

supervised.

unsupervised.

6.

Other:

 

 

 

 

 

 

 

 

Check B if you are requesting a change to legal custody, list the children affected, check 1, 2, or 3 and complete the necessary information.

Check C if you are requesting changes to support orders.

Check 1 if you are requesting changes to child support, enter the amount and frequency of the current payment and check whether it includes a deviation for health insurance. In b, check 1, 2, or 3.

Check A or B, indicate deviation information.

Check all that apply in 2- 4, and complete all relevant information for each section checked.

 

 

 

See attached

The other party and I

attempted mediation on (Date)

 

.

 

 

 

 

 

 

have not attempted mediation for this issue.

 

 

B. Legal Custody (decision making) for the following children:

1. to joint legal custody with both parents.

2. to sole legal custody with

3. Other:

See attached

C.Change the following support orders as follows:

1. Child support

a. that is currently $

 

per

 

 

that

1.

does not include a deviation for health insurance or any other reason.

2.

does include a deviation of $

 

 

 

upward

downward for

 

health insurance.

 

 

 

 

 

b. To a new amount beginning

to (Parent)

 

 

 

 

 

1.

based on state child support standards determined by the court.

2.

a new set amount of $

per

.

3.

held open (no payment).

 

 

 

 

 

 

I request that this new amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A.

not include a deviation for health insurance or any other reason.

 

 

B.

include a deviation of $

 

 

 

 

upward

downward as a

 

 

 

cash contribution for health insurance.

 

 

 

 

 

 

 

 

 

 

2.

Maintenance (Spousal Support) that is currently $

 

 

 

per

to

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

an amount beginning

 

 

 

, 20

 

to be determined by

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the court based on current income.

 

 

 

 

 

 

 

 

 

 

 

b.

a new set amount of $

per

 

 

beginning

, 20

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

Arrears payment that is currently $

 

 

 

per

 

 

 

 

to

 

 

 

a.

an amount beginning

 

, 20

 

to be determined by

 

 

the court.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b.

a new set amount of $

per

 

 

beginning

, 20

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

Arrears balance as it is currently reflected in the WI SCTF KIDS computer

 

 

 

system as $

to $

 

because

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

I have made support or other payments directly to the other party.

 

 

 

b.

I dispute the amount that is currently on record.

 

 

 

 

 

 

 

 

 

 

FA-4170V, 02/10 Notice of Motion and Motion to Change: Custody/Physical Placement/Support/Maintenance

§§767.105, 767.451, and 767.59, Wisconsin Statutes

This form shall not be modified, It may be supplemented with additional material.

Page 2 of 3

Notice of Motion and Motion to Change: Custody/Physical Placement/Support/Maintenance Page 3 of 3

Case No.

__________

 

 

 

 

I will be able to provide documentation to the court that supports my request.

NOTICE: Both parties must bring to court their fully completed, dated, and signed

Financial Disclosure Statement and all required attachments.

In D, enter any other changes you may have.

In 2, enter the date the current court order or judgment was signed by a court official.

In 3, check all that apply in A-H. If E or F, enter the party’s information that has changed. If other, enter the change in circumstance that has prompted you to bring this Motion.

D. Other change(s):

See attached

2. The court order that I am asking to be modified was dated

 

.

3.This request is based on the following substantial change in circumstances that have occurred since the entry of the prior court order in this case.

A.

A child who was living with the other parent is now living with me.

B.

A child is no longer eligible for child support because the child has reached age 18,

 

or is over 18 but under 19, and is no longer pursuing a course of education leading

 

to a high school diploma or its equivalent.

 

C.

One of the parties has or will be moving to a different residence.

D.

There is not a placement schedule and the parties cannot agree.

E.

Employment or work shift of

 

has changed.

 

both parties has changed.

 

F.

Income or wages of

 

has changed.

 

both parties has changed.

 

G. The availability or cost of health insurance has changed.

H. The party to whom maintenance is owed has remarried.

I. Other:

In 4, describe the facts that justify the change you want. Attach additional pages, if necessary.

4.The facts explaining the substantial change in circumstances or deviation in child support percentage standard are:

Sign and print your name.

Enter the date on which you signed your name.

NOTE: This signature does not need to be notarized.

See attached

If you require reasonable accommodations due to a disability to participate in the court process, please

call:at least ten (10) working days prior to the scheduled court date. Please note that the court does not provide transportation.

Signature

Print or Type Name

Date

A copy of this Notice of Motion and Motion must be served upon all other parties at least 5 business days before the date of the hearing. If service is by mail, it must be mailed at least 8 business days before the date of the hearing. See the Service Packet for more information.

FA-4170V, 02/10 Notice of Motion and Motion to Change: Custody/Physical Placement/Support/Maintenance

§§767.105, 767.451, and 767.59, Wisconsin Statutes

This form shall not be modified, It may be supplemented with additional material.

Page 3 of 3

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