Name of Form: FORM SUMMARY Proposed Parenting Plan Form Number: FA-4147V Statutory Reference: §767.41(1m), Wisconsin Statutes Benchbook Reference: Purpose of Form: To provide notice of a parent’s required proposal relating to legal custody and physical placement issues when contested. Who Completes It: Each parent is to file a proposal. Distribution of Form: Original to Clerk of Court; copies to other parent or attorney including Family Court Commissioner and Guardian ad Litem. Accompanying Forms: None, but may have supplements to provide greater detail. New Form/Modification: Modification; last update 10/06. Modifications: Updated to comply with Act 187. Added an additional signature block if both parties agree. Comments: Unless the court orders otherwise, parents are required, in an action in which legal custody or physical placement is contested, to file a written proposal for a parenting plan within 60 days after the court waives the mediation requirement under sec. 767.405(8)(b) or the mediator under sec. 767.405(12)(b) notifies the court that no agreement has been reached. If a parent does not file a proposed parenting plan, the right to contest the plan proposed by the other parent who does file may be lost. The judge can adopt the plan on file, unless the parent who did not file a plan can show mistake, inadvertence, surprise or excusable neglect. About this Form: This form is the product of the Wisconsin Records Management Committee, a committee of the Director of State Court’s Office. As a pro se form, its use is NOT mandatory but it is required to be accepted and distributed by the circuit courts of the State of Wisconsin. Date: 01/08/2009 Page 1 American LegalNet, Inc. www.FormsWorkflow.com PRINT in INK Enter the name of the county in which this case is filed. Check marriage or paternity. If paternity, enter the initials of the child. In RE: The For Official Use STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Petitioner/Joint Petitioner-Wife: First name Enter the name of the respondent. If joint petitioners, enter the name of the husband. paternity of marriage Middle name Last name and Respondent/Joint Petitioner-Husband: First name Middle name Proposed Parenting Plan Last name Case No. Enter the case number. I understand that Wisconsin law states that in an action in which legal custody or physical placement is contested: • I am required to file a proposed parenting plan within 60 days after the court waives mediation or within 60 days after the mediator notifies the court that no agreement has been reached. • If I fail to file such a plan, I may lose my right to contest the plan submitted by the other parent unless I can show good cause for my delay. Check mother or father. mother I am the father of the minor children of this case. I AM PROPOSING THE FOLLOWING PARENTING PLAN: Note: Legal custody is the right and responsibility to make major decisions about a child, except for those specific decisions described in 2, if any. A. Legal Custody 1. Legal custody of the minor children shall be as follows: Date of Birth Name of Child Joint Legal Custody Sole Legal Custody to Mother Sole Legal Custody to Father Enter the name of each child and check who you believe should have legal custody. Check who will be making the specific decisions for each subject area in a-d. If other, please specify. 2. Specific Decision Making Authority Decisions in the following listed areas will be made as follows: Decision a. b. c. d. e. Jointly By Mother By Father Non-Emergency Health Care Education/School Activities Child Care Providers Non-School Activities Other: FA-4147V, 01/09 Proposed Parenting Plan §767.41(1m), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 5 American LegalNet, Inc. www.FormsWorkflow.com Proposed Parenting Plan Note: Physical Placement is the right to have a child physically placed with a party. Page 2 of 5 Case No. _____________ B. Physical Placement In allocating the time the minor children spend between the parents, the court should award the placement on a day-to-day basis as follows: Primary Physical Equal Shared Placement to Placement Mother Name of Child Enter the name of each child and check which parent you believe should have physical placement of that child. And check a or b. If a, attach a schedule. If b, describe how placement will be shared in the chart provided. Primary Physical Placement to Father AND the physical placement schedule shall be: as listed in the attached document. a. as proposed below (on a biweekly basis): b. Mon. Tues. Wed. Thurs. Fri. Sat. Sun. Week 1 Week 2 Check 1, 2 or 3. If 1, enter the year in which the schedule will begin. Check which parent you believe should have the children for each holiday break. C. Summer and Holiday Placement Schedule The summer and holiday placement schedule should be as follows: as proposed here: 1. With Mother the With Father the following years following years HOLIDAYS Every Even Odd Every Even Odd year years years year years years a. Mother’s Day b. Memorial Day c. Father’s Day d. July 4th e. Labor Day f. Halloween g. Thanksgiving h. Christmas Eve i. Christmas Day j. New Year’s Eve k. New Year’s Day l. Religious Holiday m. Religious Holiday n. Father’s Birthday o. Mother’s Birthday p. Children’s Birthday(s) q. Other: r. Other: s. School Spring Break t. School Teacher Conventions u. Summer Break to be shared as follows: FA-4147V, 01/09 Proposed Parenting Plan §767.41(1m), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 5 American LegalNet, Inc. www.FormsWorkflow.com Proposed Parenting Plan Page 3 of 5 2. If 2, write the name of the county whose schedule you are using. If 3, enter the other schedule. Check 1 or 2. If 2, enter the name of the childcare provider and indicate in a and b the percent you propose each parent should pay toward the cost. The total amount must equal 100%. Check a, b, c, or d. If c, check 1 or 2 If d, enter the other proposal. For 2, check a, b, or c. If b or c, enter the location for the drop-off. If d, check 1,2,3 or 4. For each enter the requested information. For 3, check a or b. If b, enter how you propose the transportation costs should be paid. Check 1, or 2. 3. Case No. _____________ County standard According to the attached placement schedule. Other: See attached D. Child Care The children do not require child care. 1. The child care will be provided by 2. And the cost of child care will be paid as follows: %. a. The mother to pay %. b. The father to pay E. Transportation Issues 1. The physical transfer of the children for placement should be as follows: All transportation to and from placements will be provided by the mother. a. All transportation to and from placements will be provided by the father. b. Transportation will be shared with: c. parent with children shall deliver. 1. parent without children shall pick up. 2. d. Other: 2. Transfers of children shall take place at: parent’s home. a. halfway point: b. other location: c. d. Inter-spousal battery/domestic violence is an issue in this relationship and in order to ensure the safety of the children and/or parent, transfers of the children between the parents shall be: 1. supervised by 2. at a neutral public site 3. at a home of the following person 4. Other: 3. Transportation Costs shall be: a. paid by party who incurs the costs. b. paid as follows: F. Child Support The noncustodial parent shall be responsible for child support as follows: 1. as required by the state support guidelines (see divorce/paternity summons). 2. according to the attached proposal. Note: If the proposal is different from the state guidelines, the reason why it is different must be given. Enter the name of each child and indicate which school you propose he/she attend. G. School 1. The children will attend school at: Name of Child School/ School District 2. Education costs will be paid as follows: a. The mother to pay %. b. The father to pay %. FA-4147V, 01/09 Proposed Parenting Plan §767.41(1m), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 5 American LegalNet, Inc. www.FormsWorkflow.com Proposed Parenting Plan Check a or b. If a, enter the address. If b, enter your general location. Check a or b. If a, enter the address at which you intend to live for the next two years. If b, enter the general location of where you intend to live for the next two years. Check 1 or 2. If 1, enter your current employer and your general work schedule. If 2, enter your general employment. Enter the name of each provider. If other, enter the description along with the provider name. Check 1, 2, 3, 4 or 5. If 4, describe your payment suggestion. If 5, attach the plan. Check 1, 2, 3, 4 or 5. If 4, describe your payment suggestion. If 5, attach the plan. Check 1 or 2. If 1, enter the name of the religion. Check all that apply in 110. If other, enter a description. Page 4 of 5 Case No. _____________ H. Residence 1. Current I currently reside at: a. Address Zip State City This is an inter-spousal battery/domestic violence case; I decline to give a specific b. . address, but my general location is currently 2. Future For the next two years it is my intention to reside at: a. Address Zip State City This is an inter-spousal battery/domestic violence case; I decline to give a specific b. future address, but it is my intention to generally reside for the next two years at: . I. Current Employer I am currently employed at: 1. City Employer Days/Hrs. State This is an inter-spousal battery/domestic violence case; I decline to give my specific 2. . employment, but where I generally work is J. Health Care 1. Providers: Healthcare services will be provided to the children by the following: Doctors/Pediatrician/Clinic Eye/Optometrist Dentist/Orthodontist Insurance/Health Plan (if any) Other: 2. Expenses a. Healthcare Insurance for the minor children shall be: 1. paid by me. 2. paid by the other parent. 3. shared equally by both of us. 4. paid as follows: 5. according to the attached plan. b. Uninsured healthcare expenses shall be: 1. paid by me. 2. paid by the other parent. 3. shared equally by both of us. 4. paid as follows: 5. See attached plan. K. Religious Upbringing 1. The minor children will be raised in the following religion: 2. No religious affiliation is planned. L. Maintaining Contact with Other Parent I shall assist the children in maintaining contact with the other parent by: 1. direct contact through periods of placement. 2. telephone contact. 3. cards/letters. 4. e-mail. 5. providing copies of children’s school projects. 6. providing photographs of children participating in activities. FA-4147V, 01/09 Proposed Parenting Plan §767.41(1m), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 4 of 5 American LegalNet, Inc. www.FormsWorkflow.com Proposed Parenting Plan Page 5 of 5 Case No. _____________ assisting children with gift purchasing for other parent for birthdays and holidays. 7. assisting children with letter writing to other parent. 8. creating personal web-site for posting pictures, letters, information, comments. 9. Other: 10. (Note: Each parent is expected to take personal responsibility for contacting the schools to obtain school calendars and report cards and attending parent-teacher meetings.) Check 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10. If 8, enter the name(s) of the individuals. If 10, enter your suggested method. M. Resolving Disagreements If there are disagreements between myself and the other parent on issues that are to be joint decisions, the way to resolve the disagreements will be: the parent who has primary physical placement will decide. 1. the parent who has physical placement at the time of the disagreement will decide. 2. to allow the parent who generally made this type of decision before these court 3. proceedings were started to make the same type of decision in the future. to review the issues from the other parent’s or children’s standpoint and reconsider my 4. position. to determine whether my opposition is in good faith and in the best interests of the 5. children or whether it is an attempt to spite the other parent, if it is not in good faith or the best interests, reconsider my position. to determine whether this is a situation in which the children is/are attempting to 6. manipulate one parent against the other; if it appears to be manipulative, attempt to consult with the other parent to prevent the children from trapping us in this position. to ask for assistance from friends, relatives, clergy, or others who can be neutral and fair. 7. I would suggest the following person(s) to serve as a third-party neutral(s): 8. 9. 10. to contact the family court mediation program. Other:   Only one party needs to sign. However, if both parties agree, both should sign and print your name. Signature Print or Type Name Date Enter the date on which you signed your name.   Signature Print or Type Name Note: This signature does not need to be notarized. Date FA-4147V, 01/09 Proposed Parenting Plan §767.41(1m), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 5 of 5 American LegalNet, Inc. www.FormsWorkflow.com