Wisconsin > Statewide > Circuit Court > Family Court
Request For Court Ordered Mediation FA-4134 - Wisconsin
| Request For Court Ordered Mediation Form. This is a Wisconsin form and can be used in Family Court Circuit Court Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
FORM SUMMARY Name of Form: Form Number: Request for Court-Ordered Mediation FA-4134 Statutory Reference: Benchbook Reference: Purpose of Form: §§767.405 and 807.05, Wisconsin Statutes A party who wants to have issues concerning a legal custody or physical placement situation may use this form to request an order from the court that would require the parties to participate in mediation of those issues. The party seeking the mediation. Original will be filed with the court. served on the other parties. A copy would be Who Completes It: Distribution of Form: Accompanying Forms: Although none are specifically required, it may be best practice to attach a copy of any existing court order that covers the custody or placement issue. Modification; last update 01/06. Updated to be compliant with 2005 Wisconsin Act 443. Effective 01/07. A specific form ordering the mediation has not been prepared because each court usually has its own order. New Form/Modification: Modification: Comments: 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: 10/05/2006 American LegalNet, Inc. www.FormsWorkflow.com PRINT in BLACK ink Enter the name of the county in which this case is filed. STATE OF WISCONSIN, CIRCUIT COURT, For Official Use COUNTY Check marriage or paternity. If paternity, enter initials of child. In re the Marriage Paternity of: Petitioner/Joint Petitioner-Wife: Enter the name of the petitioner. If joint petitioners, enter the name of the wife. Enter the name of the respondent. If joint petitioners, enter the name of the husband. First name Middle name Last name and Respondent/Joint Petitioner-Husband: Request for Court Ordered Mediation First name Middle name Last name Enter the case number. Case No. Enter the name and address of the Family Court Commissioner of the county in which your case is filed. To: Circuit Court Commissioner Name Address Address City State Zip Enter your name, address, and phone numbers. From: Name Address Address City State Zip Phone (day) Phone (evening) Enter the other parent's name, address, and phone numbers. I Request Court Ordered Mediation with: Name Address Address City Describe the problems you are experiencing with the current physical placement or legal custody order. Add additional pages if necessary. State Zip Phone (day) Phone (evening) The other parent and I have been unable to work out problems with legal custody and/or physical placement. The problem(s) we have are: Add additional pages if necessary I understand that this is not a court hearing. If we are able to settle our disagreements in mediation, we may not need to go to court. I understand I must send a copy of this request to the other parent. Signature Sign and print your name. Enter the date on which you signed your name. Note: This signature does not need to be notarized. Print or Type Name Date FA-4134 Pro Se, 10/06 Request for Court Ordered Mediation §§767.405 and 807.05, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. American LegalNet, Inc. Page 1 of 1 www.FormsWorkflow.com
|
|||||||
