Free FA-4120 - Wisconsin

PRINT in BLACK ink
Enter the name of the county in which this case is filed. Check marriage or paternity. If paternity, enter initials of child. 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. Enter the case number.

STATE OF WISCONSIN, CIRCUIT COURT, COUNTY In re the Marriage Paternity of
,

For Official Use

Petitioner/Joint Petitioner-Wife:

First name

Middle name

Last name

and

Respondent/Joint Petitioner-Husband:

Affidavit of Service

First name

Middle name

Last name

Case No.

Note: A party to this action cannot serve the documents on the other party. After the documents have been served, the person serving the documents must complete the information. Enter the date [month, day, year], time and the address at which the documents were served. Check the boxes indicating the specific documents that were served. If one of the documents is an Order to Show Cause, enter the date [month, day, year] the Order To Show Cause was signed by a court official. If other, enter the name of the document. Enter the name of the party to whom the papers were served.

Under oath I state that: I am an adult resident of the State of Wisconsin. I am not a party to this action. On (date) At (address) at o'clock in the a.m./p.m.

I served copies of the following documents: Authenticated Summons and Petition Order to Show Cause and Affidavit for Temporary Order dated A blank Financial Disclosure Statement Requirement to attend parent education Order to Appear Other: Other: Other:

personally by delivering to and leaving these documents with the person served whom I know to be

FA-4120 Pro Se, 10/06 Affidavit of Service This form shall not be modified. It may be supplemented with additional material. Page 1 of 2

§801.10, Wisconsin Statutes

Take Notice: You must complete this task. STOP! Take this document to a Notary Public BEFORE you sign it. After you, the server, have been sworn by a Notary Public, sign and print your name and date the document in front of the Notary Public.

At the time of service, I signed my name, time, date, place and manner of service and upon whom service was made on the copy that was served.

Signature

Print or Type Name

Date

Have the Notary Public sign, date, and seal the document.

Subscribed and sworn to before me on (Seal)
Notary Public, State of Wisconsin

My commission expires:

FA-4120 Pro Se, 10/06 Affidavit of Service This form shall not be modified. It may be supplemented with additional material. Page 2 of 2

§801.10, Wisconsin Statutes