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Admission Of Service Form. This is a Wisconsin form and can be use in Circuit Court Statewide.
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Tags: Admission Of Service, FA-4119, Wisconsin Statewide, Circuit Court
FORM SUMMARY
Name of Form:
Admission of Service
Form Number:
FA-4119
Statutory Reference:
§801.10(4)(c)
Benchbook Reference:
FA-2
Purpose of Form:
To provide a document by which a party can voluntarily
accept service of documents without the need for formal
service of process through a third person or agency.
Who Completes It:
Pro Se person who wants to avoid formally serving
documents will generally complete the document. The
person who is voluntarily accepting service will sign it
when she or he gets the documents.
Distribution of Form:
Original will be filed with the court after the person
accepting the documents has signed it. A copy would
normally be provided to the person who has signed the
document.
Accompanying Forms:
The documents for which service is being accepted.
New Form/Modification:
Modification; last update 01/06.
Modification:
Updated to comply with 2005 Wis. Act 443.
Comments:
None
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: 10/05/2006
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PRINT in BLACK 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.
COUNTY
In re the
Marriage
Paternity of
,
Petitioner/Joint Petitioner-Wife:
First name
Enter the name of the
respondent. If joint
petitioners, enter the name
of the husband.
For Official Use
STATE OF WISCONSIN, CIRCUIT COURT,
Middle name
Last name
and
Respondent/Joint Petitioner-Husband:
First name
Middle name
Admission of Service
Last name
Case No.
Enter the case number.
I have voluntarily received a copy of the documents that are checked below:
Authenticated Summons and Petition
Check the box for each
document that is being
served.
Order to Show Cause and Affidavit for Temporary Order dated
A blank Financial Disclosure Statement
If one of the documents
is an Order to Show
Cause, enter the date
[month, day, year] the
Order To Show Cause
was signed by a court
official.
Requirement to attend parent education
Order to Appear
Other:
Other:
If other, enter the name
of the document.
The party who is
voluntarily accepting the
documents must sign and
print his/her name.
He/she must enter the date
on which the Admission
was signed.
Other:
Signature
Name Printed or Typed
Date
Note: This signature does
not need to be notarized.
FA-4119 Pro Se, 10/06 Admission of Service
This form shall not be modified. It may be supplemented with additional material.
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§801.10(4)(c), Wisconsin Statutes
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