PRINT in INK Enter the name of the county in which this case is filed. Enter the name of the petitioner. If joint petitioners, enter the name of the wife. For Official Use STATE OF WISCONSIN, CIRCUIT COURT, In RE: The marriage of COUNTY Petitioner/Joint Petitioner-Wife: First name Middle name Last name and Enter the name of the respondent. If joint petitioners, enter the name of the husband. Respondent/Joint Petitioner-Husband: Marital Settlement Agreement With Minor Children First name Middle name Last name Divorce-40101 Legal Separation-40201 Check divorce or legal separation. Case No. Enter the case number. Check 1 or 2. WE AGREE AS FOLLOWS: If 2, enter the reason you are asking for a legal separation and not a divorce. A. MARITAL RELATIONSHIP Divorce: This marriage is irretrievably broken. 1. Check a, b, or c. B. MAINTENANCE (Spousal Support) 1. For the Wife: The wife gives up her right to receive maintenance. She understands that by giving up a. maintenance at this time, she may never ask for maintenance. The wife is not requesting maintenance at this time, but leaves open her right to request it b. . Her right to request maintenance is limited to: until the following circumstance(s) only: 1. any appropriate substantial change in circumstance. 2. per month The husband shall pay maintenance to the wife in the amount of $ c. . , 20 beginning on the first day of the month of , 20 Maintenance shall end on the last day of the month of or until the wife remarries, dies, or by court order, whichever comes first. If b, enter a date and choose 1 or 2. If 1, enter the reasons. If c, enter the maintenance amount and the month and year the payments should begin and end. 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 month and year the payments should begin and end. 2. Legal Separation: This marriage is broken and the reason we are requesting a legal separation and not a divorce is: 2. For the Husband: The husband gives up his right to receive maintenance. He understands that by giving a. up maintenance at this time, he may never ask for maintenance. The husband is not requesting maintenance at this time, but leaves open his right to b. . His right to request maintenance is limited to: request it until the following circumstance(s) only: 1. any appropriate substantial change in circumstance. 2. per month The wife shall pay maintenance to the husband in the amount of $ c. . 20 beginning on the first day of the month of , or , 20 Maintenance shall end on the last day of the month of until the husband remarries, dies, or by court order, whichever comes first. FA-4150V, 01/09 Marital Settlement Agreement With Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 10 American LegalNet, Inc. www.FormsWorkFlow.com Marital Settlement Agreement With Minor Children Enter a or b. If b, check 1 or 2. If 2, enter the employer information. Note: An arrearage is an amount ordered that has not been paid and is overdue. Check a, b, c or d. If d, check 1or 2. If 1, enter arrearage amount. If 2, enter the interest rate and check A or B. If A, enter the date. If B, enter the amount of the monthly payment and the month and year the payments shall begin. For each debt owed individually or jointly, write the name, current balance, and check who will be responsible for payment. Page 2 of 10 Case No. _____________ 3. Payments shall be made: No payments are ordered to be made. a. to the Wisconsin Support Collections Trust Fund (WI SCTF) at Box 74200, b. Milwaukee, Wisconsin 53274-0200: directly from the payer to WI SCTF (only allowable if self-employed). 1. by income assignment from the payer’s employer as indicated below: 2. Employer name Address of payroll office Zip State City Fax Phone 4. Arrearages for Previously Ordered Maintenance: The amount of the maintenance arrears owed to a party shall be paid as follows: No maintenance was previously ordered. There is no amount due. a. The party has paid all maintenance as ordered. There is no amount due. b. If there are any arrearages for maintenance now or at the time of the final hearing, c. those arrearages are waived and the court financial record shall be set to zero. The parties agree that the amount of the arrears: d. shall be set as follows: $ 1. shall be determined by the court at the time of the final hearing 2. % per year and and shall be paid and earn interest at the rate of payment shall be as: . a one-time payment to the WI SCTF made by (date) A. through monthly income withholding by the WI SCTF in the amount of B. beginning on the first day of the $ until the arrearages are paid in full. , 20 month of C. MEDICAL INSURANCE No later than the date of the final hearing, each party shall notify the other party in writing of the availability of COBRA or other continuation benefits under their current health care policy. D. DEBTS AND LIABILITIES The following is a listing of ALL the debts and liabilities that we presently owe (either individually or as a couple) and who we agree shall be responsible for the payment of each debt: Creditor’s Name Note: Any and all debts disclosed on the parties’ Financial Disclosure Statements that are still unpaid should be included here and divided between the parties. Any new debts incurred should also be listed and divided. Balance To be Paid by Wife To be Paid by Husband $ $ $ $ $ $ $ $ $ $ $ $ $ If more space is necessary, attach additional sheets. The parties agree and understand that: • Each party assigned a debt shall be fully responsible for that obligation and shall not make any demands upon the other party concerning that debt. FA-4150V, 01/09 Marital Settlement Agreement With Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 10 American LegalNet, Inc. www.FormsWorkFlow.com Marital Settlement Agreement With Minor Children • • • Complete this section with as much detail as possible. Note: There are two types of property. “Real estate” includes such things as homes and land. “Personal property” includes all other things such as vehicles, clothing and other personal items, furniture, bank accounts, and retirement or investment accounts. Page 3 of 10 Case No. _____________ Any debt not listed shall be the responsibility of the party who incurred it and that party shall not make any demands upon the other party concerning that debt. Creditors are NOT bound by this agreement and each party remains liable to creditors for all marital debts. Any party who suffers a loss because of a failure of the other party to pay an assigned debt may enforce that obligation by a motion for contempt of court. E. PERSONAL PROPERTY DIVISION 1. Division: The parties agree to the final personal property division as indicated below: List the property and check if the wife or husband will have permanent use of the property once the divorce/legal separation is final. Who will have possession? Wife = W Husband = H Household Items W H Automobiles Year, Make, Model W H Life Insurance Name of Company & Policy # W H Business Interests Name of Business & Address W H Securities: Stocks, Bonds, Mutual Funds, Commodity Accounts Name of Company & # of shares W H Pension, Retirement Accounts, Deferred Compensation, 401K Plans, IRAs, Profit Sharing, etc. Name of Company & Type of Plan W H Cash and Deposit (Savings & Checking) Accounts Name of Bank or Financial Institution W H Note: If you have already divided the property, you must still disclose how you divided it below. Note: Any and all assets disclosed on the parties’ Financial Disclosure Statements should be included here and divided between the parties. If the parties have disposed of an asset from the time the Financial Disclosure was done, to the final hearing, please indicate what was disposed and what happened to it. FA-4150V, 01/09 Marital Settlement Agreement With Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 10 American LegalNet, Inc. www.FormsWorkFlow.com Marital Settlement Agreement With Minor Children If more space is necessary, mark the box and attach additional sheets. Check a or b. and list Indicate when If b, how the exchange of any items and indicate when and how any property will take place. exchange of personal property will take place. Check 1 or 2. If 2, and the parties own a primary residence, check a. If a, enter the address and Parcel Identification Number, which can be found on your real estate tax bill. Attach a copy of the legal description. Check 1 or 2. If 1, check A or B and enter other provisions, if any. If 2, check 1, 2, 3, or 4 in A or 1, 2, 3, or 4 in B for the responsibility for other expenditures that occur while the property is being sold. Enter the percentage each party shall receive in a and b. The total amount must equal 100%. If the parties own other real estate (including any timeshare interests), check b, complete the attached Schedule A. Page 4 of 10 Other Personal Property Description of Asset Case No. _____________ W H See attached 2. Exchange: The following items still need to be exchanged between the parties: None: all personal property has already been exchanged to the satisfaction of a. both parties. List of items: b. The exchange of personal property shall be made by (date) according to the following arrangements: Any item of personal property not listed in #2(b) above shall be awarded to the party who has possession at the time of the final hearing. F. DIVISION OF REAL ESTATE Neither party owns any real estate at this time. 1. One or both parties own real estate at this time. 2. Primary Residence: The parties own a primary residence located at: a. Address Zip State City Parcel Identification Number (Tax Key Number) Attached is a legal description of this property. The primary residence shall be awarded to the: 1. wife A. husband B. and that party shall be responsible for outstanding financial obligations, and the other party shall be held harmless from any liability. Other provisions including refinancing requirements, if any: See attached The residence shall be placed on the market for sale. 2. A. Pending sale, the mortgage, taxes, and insurance shall be paid by: wife. 1. husband. 2. shared equally. 3. shared as follows: 4. B. Pending sale, any necessary repairs, special assessments and other sale-related expenses shall be paid by: wife. 1. husband. 2. shared equally. 3. shared as follows: 4. The money from the sale of this residence shall be used to pay the usual costs of a sale and prorations, and any balance on the existing mortgage. Upon payment of all costs, the proceeds left from the sale shall be divided between the parties as follows: %. a. The wife to receive %. b. The husband to receive Other Real Estate: One or both of the parties own additional real estate, b. including any timeshare interests, which is disclosed and divided as set forth in the attached Schedule A. Transfer of Title: Both parties understand that this marital settlement agreement alone will not transfer title to one party or the other, but such a transfer requires a fully executed Quit Claim Deed and a Wisconsin Real Estate Transfer Return signed by the parties. FA-4150V, 01/09 Marital Settlement Agreement With Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 4 of 10 American LegalNet, Inc. www.FormsWorkFlow.com Marital Settlement Agreement With Minor Children Page 5 of 10 Case No. _____________ The party awarded a parcel of real estate shall be responsible for having the necessary documents prepared. If 1, check a or b. If 2, enter the amount. In a, check 1 or 2. In b, check 1, 2 or 3. If 2, enter the date [month, day, year]. If 3, enter the amount and date. In c, enter the percentage and check 1 or 2. In 2, check a or b. If b, check 1 or 2. If 2, indicate how the parties agree to handle the filing (expense and refund, if any). G. EQUALIZATION OF MARITAL PROPERTY DIVISION No payment is required to be made to equalize the marital property division because: 1. the property and debt division are equalized to the satisfaction of the parties. a. equalization has been accomplished through a division of real estate sale b. proceeds. is required to equalize the marital property division. A payment of $ 2. a. This payment shall be made by the: wife to the husband. 1. husband to the wife. 2. b. This payment: has already been made. 1. shall be made in a lump sum payment no later than (date) . 2. per month beginning shall be paid in the amount of $ 3. , 20 . on the first day of the month of % per year: c. The amount shall earn interest until paid in full at the rate of from the date of the final hearing. 1. from the date the payment was due. 2. H. TAXES 1. Year of Divorce/Legal Separation: • The parties agree to file their income tax returns for the year of the divorce/legal separation consistent with the rules of the IRS, Wisconsin Department of Revenue, and Wisconsin’s Marital Property law. • The parties understand that their marital status on the last day of the year determines their filing status for that year, whether married or single. • The parties acknowledge that each are responsible for seeking tax advice from a tax professional with regard to issues of this divorce/legal separation. 2. Years Before Divorce/Legal Separation: Tax returns for all previous years have been filed. a. The parties agree to file returns for the previous tax years as follows: b. share preparation expenses, tax liability, and/or refund equally. 1. Other: 2. Check 1, 2, or 3. If 2 or 3, enter the former legal surname. Enter the name, date of birth [month, day, year], of each child and check custody option. Note: To include more detail, check the box and attach a parenting plan or other separate description. I. LEGAL NAME RESTORATION Neither party requests the right to use a former legal surname. 1. The wife requests the right to use a former legal surname of 2. The husband requests the right to use a former legal surname of 3. Note: If this is an action for legal separation, the court cannot allow a spouse to resume a former legal surname unless and until the judgment is converted to a divorce. J. LEGAL CUSTODY OF MINOR CHILDREN The minor children (age 17 or younger) born to or adopted together by the parties, before or during the marriage, are listed below and the legal custody of each shall be as follows: Name of Child Birth Date Joint Legal Custody Sole Legal Custody to Mother Sole Legal Custody to Father Also see attached parenting plan or other separate description. FA-4150V, 01/09 Marital Settlement Agreement With Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 5 of 10 American LegalNet, Inc. www.FormsWorkFlow.com Marital Settlement Agreement With Minor Children Page 6 of 10 Case No. _____________ In a sole legal custody arrangement, the parent not granted sole legal custody, shall file a medical history form with the court in compliance with §767.41(7m), Wis. Stats. Note: Physical Placement means where the child lives or spends their time. K. PHYSICAL PLACEMENT OF MINOR CHILDREN The physical placement of the minor children shall be: Shared Primary Primary w/Mother w/Father Shared placement occurs when a child spends at least 25% or 92 days per year with each parent. Otherwise, one parent is considered to have primary placement. Name of Minor Child Enter the names of the children. Check shared, primary mother, or primary father for each child. and the placement schedule shall be: as listed in the attached parenting plan and/or schedule. a. as follows: b. Check a or b. If a, attach parenting plan and/or a schedule. If b, describe how placement will be shared. See attached L. CHILD SUPPORT 1. The child support is based on: (All calculations are based on gross income) 17% for one child. 25% for two children. 29% for three children. Note: Child Support 31% for four children. generally includes costs 34% for five or more children. for food, shelter, split-placement formula. clothing, shared-placement formula. transportation, personal care and serial-family payer formula. incidental recreational low-income payer formula. costs. high-income payer formula. If not based on options above, explain: For 1, check the appropriate method of calculation. 2. The parties agree that child support shall be paid as follows: per month, The husband shall pay child support to the wife in the amount of $ a. , 20 beginning on the first day of the month of per month, The wife shall pay child support to the husband in the amount of $ b. , 20 beginning on the first day of the month of No child support shall be ordered from either party at this time because c. . Note: For more information on DCF 150, contact your local Child Support Agency. In 3, enter a or b. If b, check 1 or 2. If 2, enter the employer information. 3. Payments shall be made: No payments are ordered to be made. a. to the Wisconsin Support Collections Trust Fund (WI SCTF) at Box 74200, Milwaukee, b. Wisconsin 53274-0200: directly from the payer to WI SCTF (only allowable if self-employed). 1. by income assignment from the payer’s employer as indicated below: 2. Employer name Address of payroll office Zip State City Fax Phone FA-4150V, 01/09 Marital Settlement Agreement With Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 6 of 10 American LegalNet, Inc. www.FormsWorkFlow.com Marital Settlement Agreement With Minor Children Check a, b, c or d. If d, check 1or 2. If 1, enter arrearage amount. If 2, enter the interest rate and check A or B. If A, enter the date. If B, enter the amount of the monthly payment and the month and year the payments shall begin. In 5, Enter the percentage each parent shall pay. The total amount must equal 100 %. Enter the number of days for each deadline. Note: Variable Costs are defined in DCF 150.02(29). Variable cost orders are mandatory only for shared placement situations. Page 7 of 10 Case No. _____________ 4. Arrearages for Child Support: The amount of the child support arrears owed to a party shall be paid and earn interest at the statutory interest rate. Payments shall be made as follows: No child support was previously ordered. There is no amount due. a. The party has paid all child support as ordered. There is no amount due. b. If there are any arrearages for child support now or at the time of the final hearing, c. those arrearages are forgiven and the court financial record shall be set to zero. The parties agree that the amount of the arrears: d. shall be set as follows: $ 1. shall be determined by the court at the time of the final hearing and shall be 2. paid as: . a one-time payment to the WI SCTF made by (date) A. through monthly income withholding by the WI SCTF in the amount of B. beginning on the first day of the month of $ until the arrearages are paid in full. , 20 5. Variable costs (required only in cases of shared physical placement), which are those reasonable costs above basic support costs for a minor child, including but not limited to child care costs, tuition, a child’s special needs, and other activities that involve substantial cost: a. We agree to consult with each other before incurring any variable costs requiring reimbursement. b. Shall be paid as follows (payments must be paid directly to the parent and cannot be made through WI SCTF): % of the variable costs. 1. The wife to pay % of the variable costs. 2. The husband to pay c. The request for reimbursement for variable costs shall be made in writing within days from the day the cost was incurred. Each party shall pay the required days from the date of the request. percentage within 6. Deductions for Children as dependents and exemptions for income tax purposes: Name of Child Enter the name of each child and then check the box to indicate how the deduction will be distributed. Mother to claim in all tax years Father to claim in all tax years Mother to claim in even tax years; Father to claim in odd tax years Father to claim in even tax years; Mother to claim in odd tax years 7. Any party ordered to pay child support may only claim the minor children as exemptions for federal and state income tax purposes if he or she is current in payment of child support as of December 31 of the year in which he or she intends to claim the exemption, pursuant to DCF 150.02(12) 8. Each party agrees to cooperate in signing IRS Form 8332, or other appropriate state or federal tax forms, as necessary, in order to carry out the options selected above. FA-4150V, 01/09 Marital Settlement Agreement With Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 7 of 10 American LegalNet, Inc. www.FormsWorkFlow.com Marital Settlement Agreement With Minor Children Page 8 of 10 Case No. _____________ Check a, b or c. If b or c, enter the amount, if any, that the other parent will pay. M. MEDICAL AND HEALTH CARE EXPENSES 1. Medical Insurance and Payments: The parties agree that medical insurance coverage for the minor children including medical, dental, orthodontic, hospital, psychiatric, counseling, drug and other health expenses which is offered now or may be offered by a present or future employer shall be obtained and paid by: Both parties shall provide coverage. a. per month The wife shall provide coverage and the husband shall pay $ b. directly to the wife to cover the difference between single and family coverage. per month The husband shall provide coverage and the wife shall pay $ c. directly to the husband to cover the difference between single and family coverage. Enter the percentage that each parent will pay in a and b. The total must equal 100%. This person shall also provide the other parent with copies of policy information and insurance cards. 2. Uninsured Health Care Expenses: Payments for health care expenses for the minor children not covered by insurance, including medical, dental, orthodontic, hospital, psychiatric, counseling, drug and other health expenses shall be paid as follows: % of the total amount. a. The wife to pay % of the total amount. b. The husband to pay 3. Reimbursements: Any request for reimbursement from the other party for medical insurance and uninsured health care expenses shall be made in writing. The other party days after receiving a written request. shall pay their required percentage within Enter the number of days for the deadline. Check 1 or 2. If 2, enter the name of the company who holds the policy, the policy number, and the name of the party who the policy currently insures. N. LIFE INSURANCE Each party shall keep in full force and pay the premiums on all life insurance presently held upon his or her life, naming the minor children of the parties as sole primary beneficiaries in equal shares, until the youngest of the minor children reaches age of 18 or age 19 if they are pursuing a high school diploma or its equivalent. If current coverage is lost, the party with the current life insurance policies shall provide equivalent coverage. Each party agrees to furnish the other with proof of the named sole primary beneficiary upon request. This provision may be satisfied in a will or trust. The parties do not currently have any life insurance policies in force. 1. The following life insurance policies are currently in full force: 2. Company Name Policy Number Name of Insured Neither party may borrow against any life insurance policy after the date of this agreement, nor use it as collateral, without the written consent of the other party. Check 1 or 2. If 2, attach any additional agreements. O. OTHER AGREEMENTS We understand that any oral agreements are not enforceable by the court. We have no other agreements, written or oral, concerning this marriage. 1. We have additional written agreements concerning this marriage, copies of which 2. are attached. P. AGREEMENTS and UNDERSTANDINGS We understand and agree that: • We could each get an attorney to review this agreement. • This form was provided as a convenience and may NOT cover all issues. • This agreement may have tax consequences and that seeking tax advice is suggested. • We have fully disclosed each of our income, debts, assets and liabilities to each other. • Maintenance is deductible by the payer and taxable to the payee. • Child support is NOT deductible by the payer or taxable to the payee. FA-4150V, 01/09 Marital Settlement Agreement With Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 8 of 10 American LegalNet, Inc. www.FormsWorkFlow.com Marital Settlement Agreement With Minor Children • • • • • Page 9 of 10 Case No. _____________ The parents agree that these legal custody and physical placement arrangements are in the best interests of the minor children at this time. Any court order regarding child support, legal custody, or physical placement is not final and may be modified under an appropriate change of circumstances. If the court orders child support we must annually exchange financial information. A party who fails to furnish the information as required by the court under this subsection may be proceeded against for contempt of court under ch. 785 Wis. Stats. Any court order regarding the division of property is final as of the date of the final hearing and can never be changed. There are certain legal presumptions under Wisconsin law, such as: o Marital property should be divided 50/50. o Legal custody of minor children should be granted jointly to both parents. o A child born or conceived during the marriage is presumed to be the husband’s child. Q. VOLUNTARY EXECUTION / NATURE OF AGREEMENT We assume equal responsibility for the entire content of this agreement. We have entered into this marital settlement agreement freely and voluntarily and not because of any undue influence. In some instances, the agreement represents a compromise of disputed issues. We believe the terms to be fair and reasonable under the circumstances. We acknowledge that there may be substantial legal and tax implications with regard to this agreement. We understand that lack of knowledge of the law may not be sufficient to convince the court that relief from these provisions is required. We acknowledge that each of us has the right to seek the advice of our own personal attorney. R. MUTUAL / GENERAL RELEASE We release each other from any claim of any nature that may exist. Neither of us may, at any time hereafter, sue the other, or our heirs, personal representatives, and assigns, for the purpose of enforcing any or all of the rights relinquished and/or waived under this agreement. We agree that in the event any suit shall be commenced, this release, when pleaded, shall constitute a complete defense to any such claim or suit so instituted by the other party. We understand that this mutual and general release shall not become effective until this Marital Settlement Agreement is approved by the court. S. FULL DISCLOSURE AND RELIANCE We warrant to each other that there has been an accurate, complete, and current disclosure of all income, assets, debts, and liabilities. We understand and agree that deliberate failure to provide complete disclosure constitutes perjury under §767.127, Wis. Stats. and a fraud upon the court. The property referred to in this agreement represents all the property in which either party has any interest. This agreement is based on our financial disclosure statements. We relied on these financial representations when entering into this agreement. T. RESTRAINING ORDER We agree to never interfere with the personal liberty of the other, or to go on the premises occupied by the other as a residence except with permission of that party. U. EXECUTION OF DOCUMENTS Now, or in the future, on demand, we agree to execute and deliver any and all documents that may be necessary to carry out the terms and conditions of this agreement. V. DIVESTING OF PROPERTY RIGHTS Except as otherwise provided for in this agreement, we give up all rights to the property awarded to the other. All property awarded to a party shall be the separate property of that party. We shall have the right to manage our separate property as if we had never been married. FA-4150V, 01/09 Marital Settlement Agreement With Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 9 of 10 American LegalNet, Inc. www.FormsWorkFlow.com Marital Settlement Agreement With Minor Children Page 10 of 10 Case No. _____________ W. SURVIVAL OF AGREEMENT AFTER JUDGMENT We agree that the provisions of this agreement shall survive any subsequent judgment of divorce and shall have independent legal significance. This agreement is a legally binding contract, entered into for good and valuable consideration. It is contemplated that in the future either of us may enforce this agreement in this or any other court of competent jurisdiction. X. JURISDICTION This county shall have jurisdiction for all disputes unless otherwise agreed to in writing or as provided under Wisconsin Statutes. Y. APPROVAL OF COURT REQUIRED We have read this agreement and agree with its terms. We submit this Marital Settlement Agreement to the court for approval and request the court to incorporate its terms in the final judgment. Once approved by the court, we understand that either of us may enforce this agreement in this or any other court of competent jurisdiction. Z. WAIVER OF APPEARANCE We agree that the court may proceed with the final hearing without further notice, and consent to judgment being entered on the petition, pursuant to the terms of this Marital Settlement Agreement even if the respondent or one of the joint petitioners does not appear.   The wife must sign and print her name. 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. Enter the date on which he signed his name. Note: This signature does not need to be notarized. If not, mark not required. If a Guardian ad Litem has been appointed to your case, you must take this agreement to the GAL for his/her approval. Print or Type Name Date   If either party is receiving public assistance or there is a case worker from the Child Support Agency assigned to your case, you must take this agreement to the Child Support Agency in your county for their approval. Signature of Wife Signature of Husband Print or Type Name Date State of Wisconsin, Child Support Agency Approved Not Approved Not Required Authorized Signature Print or Type Name Title Date Guardian ad Litem Approved Not Approved Not Required (no GAL has been appointed) Authorized Signature Print or Type Name If not, mark not required. Title Date FA-4150V, 01/09 Marital Settlement Agreement With Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 10 of 10 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE A – DIVISION OF OTHER REAL ESTATE A. Parcel 2: The parties own other real estate located at: Address City B. Zip State Parcel Identification Number (Tax Key Number) Attached is a legal description of this property. The real estate shall be awarded to the: 1. wife a. husband b. and that party shall be responsible for outstanding financial obligations, and the other party shall be held harmless from any liability. Other provisions including refinancing requirements, if any: See attached The residence shall be placed on the market for sale. 2. a. Pending sale, the mortgage, taxes, and insurance shall be paid by: wife. 1. husband. 2. shared equally. 3. shared as follows: 4. b. Pending sale, any necessary repairs, special assessments and other sale-related expenses shall be paid by: wife. 1. husband. 2. shared equally. 3. shared as follows: 4. The money from the sale of this real estate shall be used to pay the usual costs of a sale and prorations, and any balance on the existing mortgage. Upon payment of all costs, the proceeds left from the sale shall be divided between the parties as follows: %. a. The wife to receive %. b. The husband to receive Parcel 3: The parties own other real estate located at: Address State City Zip Parcel Identification Number (Tax Key Number) Attached is a legal description of this property. The real estate shall be awarded to the: 1. wife a. husband b. and that party shall be responsible for outstanding financial obligations, and the other party shall be held harmless from any liability. Other provisions including refinancing requirements, if any: See attached The residence shall be placed on the market for sale. 2. a. Pending sale, the mortgage, taxes, and insurance shall be paid by: wife. 1. husband. 2. shared equally. 3. shared as follows: 4. b. Pending sale, any necessary repairs, special assessments and other sale-related expenses shall be paid by: wife. 1. husband. 2. shared equally. 3. shared as follows: 4. The money from the sale of this real estate shall be used to pay the usual costs of a sale and prorations, and any balance on the existing mortgage. Upon payment of all costs, the proceeds left from the sale shall be divided between the parties as follows: %. a. The wife to receive %. b. The husband to receive FA-4150V, 01/09 Marital Settlement Agreement - With Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com