FA-4113V, 05/18 Response and Counterclaim 247247767.215 and 822.29, 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 this case was filed by your spouse. STATE OF WISCONSIN , CIRCUIT COURT, COUNTY (he/she is the petitioner). IN RE : T HE MARRIAGE OF Petitioner Name (First, Middle and Last) and On the far right, check if your spouse filed for divorce or legal separation. Response and Counterclaim D ivorce - 40101 Legal Separation - 40201 Case No. Enter your name (you are the respondent). Respondent Name (First, Middle and Last) Enter the case number. RESPONSE I am the respondent in this action. Read through section A, section B, section C, and section D of the Petition. A. I accept all the statements made in section A of the Petition to be true and correct. Yes No If all the statements are true, check yes in the appropriate section. I am making the following changes: If any statement or fact is untrue or incorrect, check no in the appropriate section and enter the correct information on the lines. B. I accept all the statements made in section B of the Petition to be true and correct. Yes No I am making the following changes: C. I accept all the statements made in section C of the Petition to be true and correct. Yes No I am making the following changes: D. I accept all the statements made in section D of the Petition to be true and correct. Yes No I am making the following changes: COUNTERCLAIM Check all boxes that apply. I REQUEST THE FOLLOWING RELIEF FROM THE COURT: A . A judgment of 1. Divorce. This marriage is irretrievably broken. If 2, explain why you are requesting a legal separation and not a divorce. 2. Legal Separation . This marriage is broken and the reason I am requesting a legal separation and not a divorce is American LegalNet, Inc. www.FormsWorkFlow.com FA-4113V, 05/18 Response and Counterclaim 247247767.215 and 822.29, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 3. Other: 4. Dismissal of this action. B. Enter other orders as it deems just and equitable. STOP! If you have minor children, 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. If you do not have minor children, sign, print your name and date. A Notary is not required. Signature Print or Type Name Address 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