S T A T E In re the O F W I S C O N S I N Marriage C I R C U I T C O U R T FAMILY COURT BRANCH K E N O S H A C O U N T Y Paternity of ______: (initials) __________________________________, Petitioner / Joint Petitioner and _________________________________, Respondent / Joint Petitioner STATE OF WISCONSIN is NOT a party STATE OF WISCONSIN IS a party Affidavit for Change of Physical Placement Case # ____________________ STATE OF WISCONSIN) )SS KENOSHA COUNTY ) ________________ , being first duly sworn on oath states as follows: (Name of party making request) 1. I am the Mother Father in this action. 2. In the last court order or judgment filed on _______________ ______, __ __ __ __ , (Month) (Day) (Year) I the other parent was awarded equal shared physical placement primary physical placement periods of physical placement no physical placement of the following minor child(ren) according to the following schedule(s) (attach additional sheet(s) if necessary): (Name)________________ (Schedule)__________________________________________ (Name)________________ (Schedule)__________________________________________ (Name)________________ (Schedule)__________________________________________ 3. This affidavit is made in support of my request that I the other parent be awarded equal shared physical placement primary physical placement periods of physical placement no physical placement of the following child(ren) according to the following schedule(s) (attach additional sheet(s) if necessary): (Name)________________ (Schedule)__________________________________________ (Name)________________ (Schedule)__________________________________________ (Name)________________ (Schedule)__________________________________________ 4. My reasons for seeking this change are as follows (attach additional sheet(s) if necessary): ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Subscribed and sworn to before me this day of , 20 . ___________________________ Notary Public, State of Wisconsin My Commission Expires:_____________ _______________________________________________ Signature of party making request 3110F-Post Judgment Forms Page 1 of 1 Affidavit for Change of Physical Placement WCCSH Rev. 10/9/02 American LegalNet, Inc. www.USCourtForms.com