FORM SUMMARY Name of Form: Proposed Marital Settlement Order without Minor Children Form Number: FA-4153V Statutory Reference: §767.34, Wisconsin Statutes Benchbook Reference: Purpose of Form: If the parties without minor children cannot reach an agreement on the issues in a marriage (such as property division, debt division, maintenance, etc.), or one party cannot be found, this document is used by a party to present to the court that party’s recommendations as to how those issues should be resolved. Who Completes It: Each party would complete his or her own version of this form. Distribution of Form: Original will be filed with the court. All other parties (including Child Support Agency, if necessary) shall be provided with a copy. Accompanying Forms: None, unless additional schedules are needed. New Form/Modification: Modification; last update 10/06. Modification: Reworked the payments paragraph and residence placed on the market for sale paragraph, added pension, 401K, IRA and Life insurance language. Comments: This form is quite inclusive and may include provisions that are not relevant to a particular situation. If a provision is not relevant, it should be marked accordingly. 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: 01/17/2008 Page 1 American LegalNet, Inc. www.FormsWorkflow.com 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 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 Last name Proposed Marital Settlement Order Without Minor Children Divorce-40101 Legal Separation-40201 Check divorce or legal separation. Case No. Enter the case number. I REQUEST THAT THE COURT GRANT THE FOLLOWING: Check 1 or 2. If 2, enter the reason you are asking for a legal separation and not a divorce. 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. 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. A. MARITAL RELATIONSHIP Divorce: This marriage is irretrievably broken. 1. Legal Separation: This marriage is broken and the reason I am requesting a legal 2. separation and not a divorce is: 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. 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. The wife shall pay maintenance to the husband in the amount of $ c. . 20 per month beginning on the first day of the month of , , 20 Maintenance shall end on the last day of the month of or until the husband remarries, dies, or by court order, whichever comes first. FA-4153V, 01/08 Proposed Marital Settlement Order Without Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 7 American LegalNet, Inc. www.FormsWorkflow.com Proposed Marital Settlement Order Without Minor Children Enter a or b. If b, check 1 or 2. If 2, enter the employer information. 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. Note: An arrearage is an amount ordered that has not been paid and is overdue. For each debt owed individually or jointly, write the name, current balance, and check who will be responsible for payment. Page 2 of 7 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. I propose 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 made as follows: . 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 I propose shall be responsible for the payment of each debt: Creditor’s Name Balance To be paid by wife To be paid by husband $ $ $ $ $ $ $ $ $ $ $ $ $ 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. If more space is necessary, attach additional sheets. The parties 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. • 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. FA-4153V, 01/08 Proposed Marital Settlement Order Without Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 7 American LegalNet, Inc. www.FormsWorkflow.com Proposed Marital Settlement Order Without 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 7 Case No. __________ Creditors are NOT bound by this proposal 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 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. Check a or b. If b, list the items and indicate when and how any exchange of personal property will take place. 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 Note: If you have already divided the property, you must still disclose how you divided it below. Household Items W H Other Personal Property Description of Asset W H FA-4153V, 01/08 Proposed Marital Settlement Order Without Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 7 American LegalNet, Inc. www.FormsWorkflow.com Proposed Marital Settlement Order Without Minor Children Check a or b. If b, list the items and indicate when and how any exchange of personal property will take place. Page 4 of 7 Case No. __________ 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. 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. 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. Check 1 or 2. If 1, check A or B. 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. The primary residence shall be awarded to the: 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. 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, including any timeshare interests, which is disclosed and divided as set forth in the attached Schedule A. 1. Attach a copy of the legal description. b. Transfer of Title: This proposed marital settlement order 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. The party awarded a parcel of real estate shall be responsible for having the necessary documents prepared. FA-4153V, 01/08 Proposed Marital Settlement Order Without Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 4 of 7 American LegalNet, Inc. www.FormsWorkflow.com Proposed Marital Settlement Order Without Minor Children 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. Page 5 of 7 Case No. __________ G. EQUALIZATION OF MARITAL PROPERTY DIVISION No payment is required to be made to equalize the marital property division because: 1. he 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 is 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. 1. share preparation expenses, tax liability and/or refund equally. 2. Other: If 2, indicate how the parties agree to handle the filing (expense and refund, if any). If 2 or 3, enter the former legal surname. 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. Check 1 or 2. 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. Check 1, 2, or 3. If 2, attach any additional agreements. I. J. OTHER PROPOSED ORDERS I have no other proposals, written or oral, concerning this marriage. 1. I have additional written proposals concerning this marriage, copies of which are 2. attached. K. UNDERSTANDINGS I understand that: • I could get an attorney to review this proposed order. • This form was provided as a convenience and may NOT cover all issues. • These proposed orders may have tax consequences and that seeking tax advice is suggested. • I have fully disclosed my income, debts, assets and liabilities to each other. • Maintenance is deductible by the payer and taxable to the payee. • 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 marital property should be divided 50/50. FA-4153V, 01/08 Proposed Marital Settlement Order Without Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 5 of 7 American LegalNet, Inc. www.FormsWorkflow.com Proposed Marital Settlement Order Without Minor Children Page 6 of 7 Case No. __________ L. VOLUNTARY EXECUTION / NATURE OF PROPOSED ORDER I assume responsibility for the entire content of this proposed order. I have proposed these orders freely and voluntarily and not because of any undue influence. I believe the terms to be fair and reasonable under the circumstances. I acknowledge that there may be substantial legal and tax implications with regard to this proposal. I understand that lack of knowledge of the law may not be sufficient to convince the court that relief from these provisions is required. I acknowledge that I have the right to seek the advice of my own personal attorney. M. GENERAL RELEASE The parties are released from any claim of any nature that may exist. Neither party may, at any time hereafter, sue the other, personal representatives, and assigns, for the purpose of enforcing any or all of the rights relinquished and/or waived under this proposal. 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. I understand that this general release shall not become effective until this Proposed Marital Settlement Order is approved by the court. N. FULL DISCLOSURE AND RELIANCE I warrant that I have provided an accurate, complete, and current disclosure of all income, assets, debts, and liabilities. I understand 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 proposed order represents all the property in which either party has any interest. This proposed order is based on my financial disclosure statement. O. RESTRAINING ORDER Neither party may 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. P. EXECUTION OF DOCUMENTS Now, or in the future, on demand, the parties shall execute and deliver any and all documents that may be necessary to carry out the terms and conditions of this proposed order. Q. DIVESTING OF PROPERTY RIGHTS Except as otherwise provided for in this proposed order, the parties 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. The parties shall have the right to manage our separate property as if we had never been married. R. SURVIVAL OF PROPOSED ORDER AFTER JUDGMENT The provisions of this proposed order shall survive any subsequent judgment of divorce and shall have independent legal significance. This proposed order is a legally binding contract, entered into for good and valuable consideration. It is contemplated that in the future either party may enforce this proposed order in this or any other court of competent jurisdiction. S. JURISDICTION This county shall have jurisdiction for all disputes unless otherwise agreed to in writing or as provided under Wisconsin Statutes. T. APPROVAL OF COURT REQUIRED I submit this proposed order to the court for approval and request the court to incorporate its terms in the final judgment. Once approved by the court, I understand that either of us may enforce this proposed order in this or any other court of competent jurisdiction. FA-4153V, 01/08 Proposed Marital Settlement Order Without Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 6 of 7 American LegalNet, Inc. www.FormsWorkflow.com Proposed Marital Settlement Order Without Minor Children Page 7 of 7 Case No. __________ U. WAIVER OF APPEARANCE 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 Proposed Marital Settlement Order even if the respondent or one of the joint petitioners does not appear. The party who is proposing the above orders must sign Enter the date on which he/she signed. Signature Print or Type Name Note: This signature does not need to be notarized. Date If the other party does later agree with your proposal you may have him/her sign and print his/her name. Signature Print or Type Name Date Note: This signature does not need to be notarized. FA-4153V, 01/08 Proposed Marital Settlement Order Without Minor Children §767.34, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 7 of 7 American LegalNet, Inc. www.FormsWorkflow.com SCHEDULE A – DIVISION OF OTHER REAL ESTATE A. B. Parcel 2: The parties own other real estate located at: Address: Zip State City: 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. 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 follow: %. a. The wife to receive %. b. The husband to receive Parcel 3: The parties own other real estate located at: Address: Zip State City: 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. 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 follow: %. a. The wife to receive %. b. The husband to receive FA-4153V, 01/08 Proposed Marital Settlement Order Without 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