Wisconsin Form Fa 4111 – Fill Out and Use This PDF

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Enter the name of the county in which you are filing this case.

Enter the wife’s name.

Enter the wife’s address.

On the far right, check divorce or legal separation.

Enter the husband’s name.

Enter the husband’s address.

Note: Leave case number blank; the clerk will add this.

STATE OF WISCONSIN, CIRCUIT COURT,

COUNTY

In RE: The marriage of

Joint Petitioner-Wife:

	First name	Middle name	Last name
	Address
	Address
	City	State	Zip
	and
	Joint Petitioner-Husband:
	First name	Middle name	Last name
	Address
	Address
	City	State	Zip

For Official Use

Joint Petition

Without Minor Children

Divorce-40101

Legal Separation-40201

Case No.

Enter the wife’s date of birth [month, day, year].

For 2, 3 and 4, check yes or no.

Military personnel:

Please see Basic Guide to Divorce/Legal Separation.

Enter the husband’s date of birth [month, day, year].

For 2, 3 and 4, check yes or no.

Military personnel:

Please see Basic Guide to Divorce/Legal Separation.

A. We are providing the following information about the wife:

1.Date of birth

2.Immediately before filing this petition, the wife will have lived in this county for 30 days

or more.
Yes	No

3.Immediately before filing this petition, the wife will have lived in the state of Wisconsin for 6 months or more.

Yes

No

4.The wife is currently on active duty as a member of the Armed Forces of the United States of America or its allies.

Yes

No

B. We are providing the following information about the husband:

1.Date of birth

2.Immediately before filing this petition, the husband will have lived in this

county for 30 days or more.

Yes

No

3.Immediately before filing this petition, the husband will have lived in the state of Wisconsin for 6 months or more.

Yes

No

4.The husband is currently on active duty as a member of the Armed Forces of the United States of America or its allies.

Yes

No

Enter the date [month, day, year], city, and state in which you were married.

Check a or b. If b, explain why you are filing for a legal separation and not a divorce.

Check a or b. If b, enter the county and state in which it was filed, the case number assigned to it and check yes or no to indicate if the case has been dismissed.

Check yes or no. If no, respond to 5a-5d with information about the wife’s most recent previous marriage.

If the wife had an additional previous marriage, respond to 5e- 5h.

Check yes or no. If no, respond to 6a-6d with information about the husband’s most recent previous marriage.

If the husband had an additional previous marriage, respond to 6e-6h.

C. We are providing the following marriage information:

1. We were married on (date)

2. We were married in (city)

(state)

3.We are filing for:

a. Divorce: This marriage is irretrievably broken.

b. Legal Separation: This marriage is broken and the reason we are requesting a legal separation and not a divorce is

4.Previous Actions

This is the first time that either my spouse or I have filed for divorce or legal separation from each other in Wisconsin or in any other state:

a. Yes

b. No: County

State Case No.

Has this case been dismissed? Yes No 5. This is the wife’s first marriage.

Yes		No
a. The wife was previously married to
b. The marriage was terminated by:						divorce.			death.
c. Date of the divorce or death
d. The divorce was granted in:
	Name of court
	City							State
e. The wife was also previously married to
f. The marriage was terminated by:						divorce.			death.
g. Date of the divorce or death
h. The divorce was granted in:
	Name of court
	City							State

If the wife had more than 2 previous marriages, repeat 5e-5h on an additional sheet.

6. This is the husband’s first marriage.

Yes

No

a. The husband was previously married to

b. The marriage was terminated by:

divorce.

death.

c. Date of the divorce or death

d. The divorce was granted in:

Name of court

City

State

e. The husband was also previously married to

f. The marriage was terminated by:

divorce.

death.

g. Date of the divorce or death

h. The divorce was granted in:

Name of court

City

State

Check a or b. If b, write the names and dates of birth of all adult children born to the wife during the marriage.

D.We are providing the following information regarding our children:

1. a. No children were born to or adopted together by us before or during our

marriage.

b. All children, who are currently age 18 or older, born to the wife during the marriage include:

Name of Child		Date of Birth

Check a or b. If a, attach a copy of the written agreement to this petition.

If you are requesting maintenance (spousal support) at this time, check yes. If not, check no.

2. To the best of our knowledge, the wife in this marriage:

a.	is currently pregnant. (An attorney [guardian ad litem] for the unborn child will
	be required if the husband is not the father.)
b.	is not currently pregnant.

3.We have made written agreements or received orders from the court about some or all of the matters in this action such as maintenance (spousal support) or property division.

a. Yes, and we have attached a copy of the written agreement to this Petition.

b. No

We consent to jurisdiction and waive service of summons.

WE ASK THAT THE COURT:

1.Grant a judgment as requested.

2.Enter an order granting maintenance.

Yes

No

3. Enter other orders as it deems just and equitable.

The wife must sign and print her name.

She must enter the date on which she signed her name.

Note: This signature does not need to be notarized.

The husband must sign and print his name.

He must enter the date on which he signed his name.

Note: This signature does not need to be notarized.

Signature of Wife

Print or Type Name

Date

Signature of Husband

Print or Type Name

Date