Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: FA-4128VA, 05/18 Affidavit to Show Cause and Request for Hearing for Temporary Order with Minor Children 247247767.117, 767.127 and 767.225, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 Enter the name of the county in which you are filing this case. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Enter the name and address of Petitioner/ Joint Petitioner A. IN RE : T HE MARRIAGE OF Petitioner/Joint Petitioner A Name (First, Middle and Last) Address Address City State Zip a nd Affidavit to Show Cause and Request for Hearing for Temporary Order With Minor Children D ivorce - 40101 Legal Separation - 40201 Case No. Enter the name and address of Respondent/ Joint Petition er B . Respondent/Joint Petitioner B Name (First, Middle and Last) Address Address City State Zip Check divorce or legal separation. Enter the case number, if known. If unknown, leave blank. 1. The other party and I have not agreed on a temporary arrangement while this action is pending, and there is a need for such an order. 2. I request that a hearing be held and a temporary order be entered concerning one or more of the following issues: A. Legal custody and physical placement B. Child support C. Maintenance D. Use of the residence and other property E. Payment of debts and financial obligations F. Payment of insurance and health care expenses G. Other relief the court believes appropriate H. Other relief as follows: List a ny additional disputed matters you need resolved at the temporary hearing. See attached If you require reasonable accommodations due to a disability to participate in the court process, please call prior to the scheduled court date. Please note that the court does not provide transportation. American LegalNet, Inc. www.FormsWorkFlow.com Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: FA-4128VA, 05/18 Affidavit to Show Cause and Request for Hearing for Temporary Order with Minor Children 247247767.117, 767.127 and 767.225, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 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. Signature Print or Type Name Date 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: American LegalNet, Inc. www.FormsWorkFlow.com