Form Fa 4171 PDF Details

Navigating family law in the State of Wisconsin, particularly when it involves significant life changes such as modifications to child support, legal custody, or physical placement, is a journey marked by paperwork and legal procedures. Central to this process is the FA-4171 form, a document designed to facilitate these requests through the circuit court. Individuals are required to provide detailed information, including full names, addresses, and the initial case number, ensuring the court accurately identifies the original case context. Crucial elements such as whether the motion involves marriage or paternity issues, and specifics about the changes sought to child support, custody, or maintenance, must be clearly marked and detailed. The form mandates personal service of the order and accompanying affidavit on all other parties involved, setting a timeline that demands attention and precision. Particularly noteworthy is the affidavit section that requires a petitioner to articulate the substantial changes in circumstances that justify their request for modification, a task that necessitates a clear-eyed assessment of recent life changes and their impact on existing court orders. This form, rooted in Wisconsin Statutes §§767.59, 767.451, and 767.105, stands as a testament to the state's structured approach to addressing the evolving needs of families in the aftermath of divorce or separation. It underscores the legal system's recognition of life's inherent unpredictability and its impact on agreements once thought to be final.

QuestionAnswer
Form NameForm Fa 4171
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesArrears, supplemented, spousal, WISCONSIN

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Enter the name of the

 

STATE OF WISCONSIN, CIRCUIT COURT,

 

 

 

 

 

For Official Use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

county in which the

 

 

 

 

 

 

 

 

 

COUNTY

 

 

 

 

 

 

original case was filed.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check marriage or

 

In re the

Marriage

Paternity of

,

 

 

 

 

 

 

 

 

 

paternity. If paternity,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

enter initials of child.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Enter the name, address,

 

Petitioner/Joint Petitioner:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and daytime phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

number of the petitioner or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First name

 

Middle name

 

Last name

 

 

 

 

 

 

 

 

 

 

 

joint petitioner from the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

original case file.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current Mailing Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

On the far right, mark the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

box for the change(s) you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Order To Show Cause

are requesting and enter

 

City

State

Zip

Daytime phone number

 

 

 

 

 

 

 

 

 

 

 

 

and Affidavit to:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the original case number.

 

Vs.

 

 

 

 

 

 

 

 

 

 

 

 

Change Legal Custody

 

 

 

Respondent/Joint Petitioner:

 

 

 

 

 

 

 

 

 

Change Physical Placement

Enter the name, address,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Change Child Support

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Change Maintenance

and daytime phone

 

First name

 

Middle name

 

Last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other:

number of the respondent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

or joint petitioner from the

 

Current Mailing Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

original case file.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

State

Zip

Daytime phone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check if the State of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wisconsin is a party or

 

The State of Wisconsin (Child Support Agency)

 

 

 

 

Case No.

 

is

 

 

 

 

 

 

 

 

 

 

 

not. If you are unsure,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

you may call your local

 

is not a party to this action.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Child Support Agency.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ORDER TO SHOW CAUSE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Enter the name of the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

party you want to appearUpon the attached Affidavit, IT IS ORDERED THAT:

 

 

 

 

 

 

 

 

 

 

 

in court.

Before:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For Court Use Only:

 

Location:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This section will be

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

completed by the court.

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Time:

 

 

 

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

 

 

 

 

 

 

 

 

 

to show cause (given reasons) why the requests in the attached affidavit should not be granted.

 

 

 

If you do not appear as indicated, the court may proceed without you and grant the request.

IT IS FURTHER ORDERED that:

•A copy of this order and affidavit be personally served upon all other parties at least 5 business days before the date of the hearing.

•Both parties bring to court a fully completed, dated, and signed Financial Disclosure Statement and all required attachments.

BY THE COURT:

Signature

For Court Use Only

Name Printed or Typed

 

Date

 

 

 

 

FA-4171 Pro Se 10/06 Order To Show Cause and Affidavit to change support/ legal custody/physical placement

§§767.59 and 767.451, 767.105 Wisconsin Statutes

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

Page 1 of 3

If you are requesting any

changes to legal custody or physical placement,

check A, enter the names of the children involved, and check all that apply in 1-6. Complete all relevant information, and attach a copy of your proposed placement schedule, if applicable.

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

If you are requesting any changes related to a

support order, check B,

check all that apply in 1- 4, and complete all relevant information for each section checked.

AFFIDAVIT

1.I am requesting that the court:

A.

Change the existing legal custody or physical placement of the following children:

1.

To joint legal custody with both parents.

 

 

 

 

 

2.

To sole legal custody with me.

 

 

 

 

 

3.

From primary physical placement with (name of parent):

____________ to

 

(name of parent):

 

.

 

 

 

 

4.

From share placement to primary placement with (name of parent):

 

 

 

5. From the current placement schedule (if any) to a new schedule I HAVE ATTACHED.

6. To require placement be supervised unsupervised.

 

The other party and myself

attempted mediation on (date)

 

 

 

 

 

 

 

 

 

 

have not attempted mediation for this issue.

 

 

 

 

 

 

 

 

 

B.

Change the following support orders as follows:

 

 

 

 

 

 

 

 

 

 

1.

Child support that is currently $

 

 

 

per

 

 

to:

 

 

a.

A new amount based on state child support standards determined by the

 

 

 

 

court.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b.

A new set amount of $

 

 

 

per

 

.

 

 

c.

Held open as of (date)

 

 

.

 

 

 

 

 

 

 

 

 

d. Payments to be made by (name of parent)

 

 

 

 

 

 

 

.

 

2.

Maintenance (spousal support) that is currently $

 

 

 

 

 

 

 

per

 

 

 

 

 

 

to

 

 

 

 

 

 

 

 

 

 

 

a.

An amount to be determined by the court based on current income.

 

 

 

 

 

b.

A new set amount of $

 

 

 

per

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

Arrears payment that is currently $

 

 

 

per

 

.

 

 

 

to:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

An amount to be determined by the court.

 

 

 

 

 

 

 

 

 

 

 

b.

A new set amount of $

 

 

 

per

.

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

 

 

 

 

 

 

 

 

 

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

Enter the date the current court order or judgment was signed by a court official.

Check all that apply in A-G. If other, enter the change in circumstance that has prompted you to bring this Motion.

C. 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.

Employment or work shift of

the other party

myself has changed.

E.

Income or wages of

the other party

myself has changed.

F.

The party to whom I owe maintenance has remarried.

G.

Other:

 

 

 

 

 

 

FA-4171 Pro Se 10/06 Order To Show Cause and Affidavit to change support/ legal custody/physical placement §§767.59 and 767.451, 767.105 Wisconsin Statutes

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

Page 2 of 3

Describe the facts that justify the change you want. Attach additional pages, if necessary.

4. The facts explaining the substantial change in circumstances are:

See Attached

If you need help in this matter because of a disability, please call:

STOP!

Take this document to a Notary Public BEFORE you sign it.

After you have been sworn by a Notary Public, sign and print your name and date the document in front of the Notary Public.

Have the Notary Public sign, date, and seal the document.

Subscribed and sworn to before me

on

Notary Public, State of Wisconsin

My commission expires:

Signature

Print or Type Name

Date

A copy of this Order to Show Cause and Affidavit must be served upon all other parties at least 5 business days before the date of the hearing. See the Service Packet for more information.

FA-4171 Pro Se 10/06 Order To Show Cause and Affidavit to change support/ legal custody/physical placement §§767.59 and 767.451, 767.105 Wisconsin Statutes

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

Page 3 of 3

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