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Stipulation And Order To Change FA-604 - Wisconsin
| Stipulation And Order To Change Form. This is a Wisconsin form and can be used in Family Court Circuit Court Statewide . |
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FORM SUMMARY Name of Form: Stipulation and Order to Change: Custody/Placement/Support/ Maintenance Form Number: FA-604 ________________________________________________________________ Statutory Reference: §§767.451, 767.461, 767.553, 767.59 and 767.89, Wisconsin Statutes Benchbook Reference: Purpose of Form: FA 14 This form allows parties to stipulate to certain modifications of an original family court judgment for child placement, custody and support issues. This eliminates need for a court hearing. Parties who seek the change complete the form and present it to the Child Support Agency and the court. Original to court, copies to each of the parties. The child support agency should also receive a copy of the order prior to filing for approval, if required. Generally none. Modification; last update 01/09. New rule which took effect Jan. 1, 2010 to DCF 150, the Percentage of Income Standard which creates requirements for establishing medical support orders. Under the new rules, a parent who has insurance coverage available that means certain defined criteria must carry that coverage and the other parent may be ordered to contribute to the cost of that coverage. That contribution would be in the form of an upward or downward deviation in the child support amount dependent on which parent is the court ordered payee. This form is for use in divorce and paternity cases. The form allows the modification of child support, family support and maintenance orders as well as issues related to placement and other non-property matters. The only way for the parties to avoid a wage assignment is for the court to make a finding of irreparable harm to the payer or because the parties have an account transfer under §767.267. If the parties are now or have in the past been the recipients of some form of public assistance (i.e. W2, food stamps, medical assistance, child care subsidy, etc.), the local child support agency must be notified before the court signs any order affecting a child support obligation to ensure that the interests of the public are protected. Child support must "sign off" on the agreement under those circumstances in the signature block provided for that agency prior to the court signing the order. The procedures for accomplishing this would be county specific. Who Completes It: Distribution of Form: Accompanying Forms: New Form/Modification: Modifications: 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. Approval Date: 02/11/2010 Release Date: 09/20/2010 Posted Date: 09/22/2010 -1 American LegalNet, Inc. www.FormsWorkFlow.com Enter the name of the county in which the original case was filed. Mark marriage or paternity. If paternity, enter initials of child. Enter the name, address, and daytime phone number of the petitioner or joint petitioner from the original case file. On the far right, mark the box for the change(s) you are requesting and enter the original case number. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY In RE: The marriage paternity of For Official Use Petitioner/Joint Petitioner: First name Middle name Last name Current Mailing Address City State Zip Daytime phone number vs. Stipulation and Order to Change: Legal Custody Physical Placement Child Support Maintenance Family Support Arrears Balances Other: Enter the name, address, and daytime phone number of the respondent or joint petitioner from the original case file. Mark if the State of Wisconsin is a party or not. If you are unsure, you may call your local Child Support Agency. Respondent/Joint Petitioner: First name Middle name Last name Current Mailing Address City State Zip Daytime phone number The State of Wisconsin (Child Support Agency) is is not a party to this action. Case No. In 1A and B, complete the gross income (before taxes) for both parties. In C, enter the number of children subject to child support. In D, check 1 or 2 to indicate if private health insurance is available. If 2, indicate who provides the insurance and how much it costs. In 2, check all that apply in A-I. If I. enter the change in circumstance that has prompted you to make this agreement. Findings/Basis: The parties agree that the requested changes are based on the following facts: 1. Current Income and Other Information Employer A. Wife/Mother Gross monthly income$ Employer B. Husband/Father Gross monthly income$ children subject to the child support standard. C. Parties have D. Health insurance for the children. A comprehensive private health insurance policy is not available to either parent at a 1. reasonable cost and/or neither parent's income is currently more than 150% of the federal poverty level. provides health insurance at the cost 2. . per of $ 2. Basis for Change This agreement is based on the following substantial change in circumstance(s) that have occurred since the entry of the prior court order in this case: . is now living with a child who was living with A. a child is no longer eligible for child support because the child has reached age 18, or is B. over 18 but under 19, and is no longer pursuing a course of education leading to a high school diploma or its equivalent. one of the parties has or will be moving to a different residence. C. there was not a placement schedule and the parties could not agree. D. E. the availability or cost of health insurance has changed. both parties has changed. employment or work shift of F. both parties has changed. G. income or wages of the party to whom maintenance is owed has remarried. H. Other: I. See attached FA-604, 02/10 Stipulation and Order to Change: Custody/Physical Placement/Support/Maintenance Page 1 of 5 §§767.451, 767.461, 767.59, and 767.89, Wisconsin Statutes American LegalNet, Inc. www.FormsWorkFlow.com This form shall not be modified. It may be supplemented with additional material. Stipulation and Order to Change: Support/Maintenance/Custody/Placement/Maintenance Page 2 of 5 Case No. ______________ Agreements: The parties agree that the judgment or order in this case should be changed as follows, and that the court may enter this stipulation as an order without a court hearing. If you are modifying 1. financial orders, check 1. Complete all sections you are changing in 1A1H. If you are changing child support, chec
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