Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: FA-4121V, 11/18 Affidavit of Mailing 247801.14, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. 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 RE: THE MARRIAGE PATERNITY OF Petitioner/Jo int Petitioner A Name (First, Middle and Last) and Enter the name of the respondent. If joint petitioners, enter the name of Respondent/Joint Petitioner B. Affidavit of Mailing Case No. Respondent/Joint Petitioner B Name (First, Middle and Last) Enter the case number. AFTER you have mailed the documents, you must complete the information to the right by checking the boxes indicating the specific documents that you mailed. To review decision for a harassment or domestic abuse injunction, u se Motion for DeNovo H earing (CV - 503) form . UNDER OATH I STATE: I placed in an envelope a copy of the following documents: A blank Income and Expense Statement (FA - 4138 V ) form A blank Financial Disclosure Statement (FA - 4139V) form Requirement to attend parent education Motion for and Notice of New (De Novo) Hearing (FA - 4130 V ) form Response and Counterclaim (FA - 4113 V ) form Notice of Motion to Change: (FA - 4170 V /FA - 4171 V - Post Judgment) form Motion for: If a motion, enter the type of motion. Other: Enter the date [month, day, year] on which you placed the documents in a mailbox, and the name and address of the person to whom you mailed them. I mailed that envelope with proper postage affixed on [Date] , 20 to : Name Address Address City State Zip STOP! Take this document to a Notary Public BEFORE you sign it. After you have been sworn by a Notary Public, sign and print your name and date the document in front of the Notary Public. Have the Notary Public sign and date . State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Signature Print or Type Name Date American LegalNet, Inc. www.FormsWorkFlow.com