Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: FA-4119V, 05/17 Admission of Service 247801.10(4)(c), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 1 Enter the name of the county in which this case is filed. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Enter the name of the petitioner. If joint petitioners, enter the name of Petitioner/ Joint Petitioner A . IN R E : T HE MARRIAGE OF Petitioner/Joint Petitioner A Name (First, Middle and Last) a nd Enter the name of the respondent. If joint petitioners, enter the name of Respondent/Joint Petitioner B. Admission of Service Case No. Respondent/Joint Petitioner B Name (First, Middle and Last) Enter the case number. Check the box for each document that is being served. On [Date] I received a copy of the following documents: Authenticated Summons and Petition 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. Order to Show Cause and Affidavit for Temporary Order [ Date d ] A blank Financial Disclosure Statement Proposed Marital Settlement Agreement /Order [ Date d ] Order to Appear [ Date d ] Motion/Order to Show Cause for Contempt [ Date d ] Motion/Order to Show Cause to Change: [ Date d ] Requirement to attend parent education If other, enter the name of the document. Other: Other: Other: The party who is voluntarily accepting the documents must sign and print their name. They must enter the date on which the Admission was signed . Note: This signature does not need to be notarized. Signature Name Printed or Typed Date American LegalNet, Inc. www.FormsWorkFlow.com