The Wisconsin FA-604 form is a legal document used to request changes in custody, physical placement, support, or maintenance related to a family law case. This form allows parents to modify existing court orders based on new circumstances, such as changes in income or living arrangements. If you need to make adjustments to your current family support agreements, fill out the form by clicking the button below.
The Wisconsin FA 604 form plays a crucial role in family law, particularly for those navigating changes in child custody, support, and maintenance agreements. This form is primarily used to request modifications to existing court orders, reflecting significant life changes that may affect the financial or custodial arrangements of children. When filling out the FA 604, individuals must specify whether the case pertains to marriage or paternity, and include pertinent details such as the names and contact information of all parties involved. The form requires information about the original case, including case numbers and the specific changes being requested. It covers various aspects, including legal custody, physical placement, child support, and maintenance, allowing for a comprehensive update to existing orders. Additionally, it prompts users to outline the reasons for the requested changes, such as changes in income, living arrangements, or the availability of health insurance. Understanding how to accurately complete this form is essential for ensuring that the court can make informed decisions that serve the best interests of the children involved.
The Wisconsin FA-604 form is used to request changes to existing court orders related to legal custody, physical placement, child support, and maintenance. This form allows parties to stipulate their agreement on modifications without needing a court hearing.
Both parents or joint petitioners involved in a custody or support case must fill out the FA-604 form. It is essential for those who wish to modify existing orders regarding child support, custody, or placement. Each party must provide their current information and agree on the proposed changes.
Key information required includes:
The form includes sections where you can check boxes to indicate the specific changes you are requesting. You will need to provide details about the current orders and the proposed new amounts or arrangements. Be sure to complete all relevant sections to ensure clarity.
No, if both parties agree on the changes, the court may approve the stipulation without a hearing. However, if there are disagreements or if the court needs further clarification, a hearing may be scheduled.
Once submitted, the court will review the FA-604 form along with any supporting documents. If approved, the court will issue an order that reflects the agreed-upon changes. It is important to ensure that all provisions of the original order not affected by the new agreement remain in effect.
When filling out the Wisconsin FA-604 form, clearly indicate the county where the original case was filed. This helps ensure that the court processes your request correctly.
Specify whether the case involves marriage or paternity. If it’s paternity, include the initials of the child involved. This distinction is crucial for proper legal categorization.
Accurate information is essential. Provide the name, address, and daytime phone number of both the petitioner and respondent. This ensures that all parties can be contacted regarding the case.
Check the appropriate boxes to indicate any changes you are requesting. This could include changes to legal custody, physical placement, or child support. Clarity in your requests will facilitate a smoother review process.
Document any changes in circumstance that justify your request for modifications. Examples include changes in income, living arrangements, or health insurance availability. These details support your case for adjustment.
Ensure that you include the current child support order and specify any deviations from the standard calculation. This transparency helps the court understand your financial situation and the rationale behind your requests.
Lastly, if either party is receiving public assistance, or if a Guardian ad Litem is involved, the agreement must be submitted for approval to the relevant agency. This step is critical for compliance with state regulations.
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Enter the name of the
STATE OF WISCONSIN, CIRCUIT COURT,
county in which the
COUNTY
original case was filed.
Mark marriage or
paternity. If paternity,
In RE: The
marriage
paternity of
enter initials of child.
Enter the name, address,
Petitioner/Joint Petitioner:
and daytime phone
number of the petitioner
First name
Middle name
Last name
or joint petitioner from
the original case file.
Current Mailing Address
On the far right, mark
the box for the change(s)
City
State
Zip
Daytime phone number
you are requesting and
vs.
enter the original case
number.
FOR OFFICIAL USE
Stipulation and
Order to Change:
Legal Custody
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:
The State of Wisconsin (Child Support Agency)
is
is not a party to this action.
Physical Placement
Child Support
Maintenance
Family Support
Arrears Balances
Other:
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
A. Wife/Mother
Gross monthly income $
Employer
B. Husband/Father
C. Parties have
children subject to the child support standard.
D. Health insurance for the children.
1.
A comprehensive private health insurance policy is not available to either parent at a
reasonable cost and/or neither parent’s income is currently more than 150% of the
federal poverty level.
2.
provides health insurance at the cost of $
per
.
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:
A.
a child who was living with
is now living with
B.
a child is no longer eligible for child support because the child has reached age 18, or is
over 18 but under 19, and is no longer pursuing a course of education leading to a high
school diploma or its equivalent.
C.
one of the parties has or will be moving to a different residence.
D.
there was not a placement schedule and the parties could not agree.
E.
the availability or cost of health insurance has changed.
F.
employment or work shift of
both parties has changed.
G.
income or wages of
H.
the party to whom maintenance is owed has remarried.
I.
See attached
FA-604, 02/10 Stipulation and Order to Change: Custody/Physical Placement/Support/Maintenance
§§767.451, 767.461, 767.59, and 767.89, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 1 of 5
Stipulation and Order to Change: Support/Maintenance/Custody/Placement/Maintenance Page 2 of 5
______________
If you are modifying financial orders, check
1.Complete all sections you are changing in 1A- 1H.
If you are changing child support, check 1.A. In 1, enter the current child support order and check a or b. If b, check 1 or 2 and complete as required.
In 2, check the standard calculation that applies to the specifics of this case after considering the gross income of the parties, other payment obligations of the parties, and physical placement of the children.
Enter support amount based on standard calculation, frequency of payment and which party is paying. Check a or b. If b, check 1 or
2.If 2, explain and indicate the new child support amount based on the deviation.
If you are changing any category in B-G, check the type of support you are changing.
In 1, enter the current order by indicating the current support amount, the frequency of payment, and the name of party who currently pays or owes the money.
In 2, indicate the month, day and year the new payment should begin and what you have agreed to change the support amount to by checking a or b. If b, enter the amount of the order, the frequency of the payment, and indicate which parent will be making the payments.
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.
1. Modify Current Financial Order(s) A. Child Support
1. Is currently
held open ($0)
$
% per
. The
amount is paid by
to
. This
child support order
a. did not deviate from the percentage standard for any reason.
b. did deviate from the percentage standard when it was set because:
The cost of health insurance paid by
2. Other reasons as follows:
2.Shall be changed to a new amount that is based on the gross income above and the following percentage of income standard:
17% for one child.
*split-placement formula.
25% for two children.
*shared-placement formula.
29% for three children.
**serial-family parent formula.
31% for four children.
low-income payer formula.
34% for five or more children
high-income payer formula.
*Shared-placement or Split-placement:
Describe or attach the placement percentage of time with each parent.
**Serial-family parent:
Describe or attach the calculation.
Based on this standard, the support order in this case would be $
and paid by
We agree to
a.
set support based on this standard beginning
, 20
b.
deviate from the amount of support calculated above because:
A cash medical contribution toward the cost of medical and health expenses
increases decreases this child support amount by $
Other (explain the reason you agree support should be different than the standard amount)
This other deviation increases decreases the standard amount by
$.
After calculating the deviation(s), we agree to set child support to $
beginning
That is currently
$0
and paid
by (Name)
Shall be changed to the following beginning
$0.
and paid by (Name)
%
Page 2 of 5
Stipulation and Order to Change: Support/Maintenance/Custody/Placement/Maintenance Page 3 of 5
Arrears Payment
1.That is currently
(Name)
Arrears Interest Payment
Child Support Arrears Balance
and owed by (Name)
$ 0.
Child Support Interest Arrears Balance
If I, describe the other financial agreements in as much detail as possible. Include amounts, dates, names, etc.
In 2, check A or B.
If B, check 1 or 2.
If 2, complete the payer’s employer
information. In 3, if you are requesting changes to physical placement check A and enter the names of the children for whom you have agreed to changes.
Check 1, 2, 3, or 4, enter the parents’
names as requested and enter or attach the new placement schedule.
Other Arrears Balance
For (type(s) of arrears)
that is currently
owed by (Name)
I. Other Financial changes as follows:
2.Payments shall be made
A. no payments are ordered.
to the Wisconsin Support Collections Trust Fund (WI SCTF) at Box 74200, Milwaukee,
Wisconsin 53274-0200
directly from the payer to WI SCTF (only allowable if self-employed).
by income assignment from the payer’s employer as indicated below:
Employer name
Address of payroll office
Phone
Fax
3.Modify
Physical Placement Order(s) (time with children) for the following children:
from primary physical placement with (Name of Parent)
to primary placement with (Name of Parent)
from shared placement to primary placement with (Name of Parent)
3.
from primary placement to shared placement.
Page 3 of 5
Stipulation and Order to Change: Support/Maintenance/Custody/Placement/Maintenance Page 4 of 5
If making a change to terms of placement related to supervision, check 5 and complete all relevant information. If other, check 6 and enter the specific information.
If you are requesting changes to legal custody check B and enter the names of the children for whom you have agreed to changes. Check 1, 2, or 3 and enter the requested information.
If you are modifying anything else, check and complete 4.
4.
from the current shared placement schedule (if any) to a new shared placement schedule.
The new placement schedule for the changes in 1-4 above is as follows:
5.
to require placement with (Name of Parent)
be
supervised.
unsupervised.
6.
Legal Custody (decision making) for the following children:
to joint legal custody with both parents.
to sole legal custody with (Name of Parent)
4. Additional changes as follows:
THE COURT ADOPTS AS FINDINGS THE FACTS SET FORTH ABOVE.
THE COURT FURTHER FINDS:
For Court Use Only.
Deviation from the child support percentage standards meets the requirements of §767.511(1n), Wisconsin Statutes.
1.Amount support would be using percentage standard is as set forth in Agreements 1.A.2.
2.Amount support deviates from percentage standard is as set forth in Agreements1.A.2.b.
3.The percentage standard is unfair
for the reasons set forth in 1.A.2. Other:
4. The basis for the modification is
as set forth above. Other:
THE COURT ORDERS:
1.This stipulation is approved and the previous judgment or order is amended accordingly.
2.All provisions of the previous judgment or order not amended by this order remain in full effect.
3.Whenever private, accessible and reasonably-priced health insurance becomes available to either parent at a reasonable cost, that parent shall enroll the child(ren) as covered dependents under his/her health insurance, unless the child(ren) are already enrolled under another private health insurance plan or unless the parent's income is below 150% of the federal poverty level.
Page 4 of 5
Stipulation and Order to Change: Support/Maintenance/Custody/Placement/Maintenance Page 5 of 5
The former wife/mother must sign and print her name.
Enter the date on which she signed her name.
NOTE: This signature does not need to be notarized.
The former husband/father must sign and print his name.
Enter the date on which he signed his name.
If either party is receiving public assistance or there is a case worker from the Child Support Agency assigned to your case, you must take this agreement to the Child Support Agency in your county for their approval.
If not, mark not required.
If a Guardian ad Litem has been appointed to your case, you must take this agreement to the GAL for his/her approval.
Wife/Mother
Print or Type Name
Date
Husband/Father
State of Wisconsin, Child Support Agency
Approved
Not Approved
Not Required
Authorized Signature
Guardian ad Litem
Not Required (No GAL has been appointed)
BY THE COURT:
Circuit Court Judge
Circuit Court Commissioner
Page 5 of 5