Order to Show Cause to Revise a Judgment
Manitowoc County · Manitowoc County · meeting of May 7, 2026 · Agenda packets
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ORDER TO SHOW CAUSE PACKET
$30.00 fee for change of your child support order
$50.00 fee for change in physical placement of minor children
MANITOWOC COUNTY'S INSTRUCTIONS FOR PRO SE MODIFICATION OF JUDGMENT/ORDER
1) Complete the Order to Show Cause and to Change (Form FA-4171VB) and Declaration to Show Cause and to
Change (Form FA-4171VA). Instructions to complete the forms are in the left hand margin.
2) Fill out the Income and Expense Statement (Form FA-4138V).
3) Complete a Petition for Waiver of Fees and Costs - Declaration of Indigency (Form CV-410A) and Order on
Petition for Waiver of Fees and Costs (Form CV-410B), if you are unable to pay the court fees/costs and meet
certain guidelines.
4) After completion of the forms above, call the Family Court Commissioner's office at (920) 683-4493 to
schedule a time to bring them to the Family Court Commissioner's office.
5) Bring completed forms to the Family Court Commissioner's office, Room 309, 1010 S. 8th Street, Manitowoc.
6) The Court will review the documents. If a hearing is appropriate, the Court will schedule the hearing and
complete the Order to Show Cause.
7) Take the completed Order to Show Cause and Declaration to the Clerk of Circuit Court office, Room 105, and
pay the appropriate filing fee, if any.
8) The Clerk of Court office will provide you with four copies after the Order to Show Cause is filed.
9) Deliver one copy of the Order to Show Cause and Declaration to the Child Support Agency (Room 119, 1st
Floor), if they are not an electronic filed party.
10) Keep one copy of the Order to Show Cause and Declaration for your records.
11) Give two copies of the Order to Show Cause and Declaration to the person serving the documents on the other
party. Have the other party personally served with a copy of the Order to Show Cause and Declaration. See
the Service Packet (Form FA-SOOOV) for options and procedural instructions.
Deadline: The other party(s) must be notified properly with the forms at least five (5) business days before the
date of the hearing.
12) After the other party has been served, the Sheriff's Department will provide you with the copy of the Proof of
Service (also called an Affidavit of Service OR Certificate of Service). Make a copy of this document for yourself
and file the original with the Clerk of Court office in Room 105, 1010 S. 8th Street, Manitowoc. THIS MUST BE
DONE PRIOR TO YOUR HEARING or you may not be able to have a hearing.
13) Attend the court hearing on the appropriate date and time. Be there on time! Bring all the information and
exhibits with you that you think the court should see or may need to decide the case. Bring four copies of
everything you want to present to the court. Be prepared to tell the court why you feel the current order
should be changed.
g:\family\forms\instructions for filing a n order to show cause action -- May 7, 2026
14) Special procedures required for custody or physical (visitation) disputes:
If your request is to change legal custody or periods of physical placement (visitation), and the other party
indicates to the court that he/she does not agree to what you are requesting, your hearing may be adjourned
in order to allow the following:
Step One: Mediation
First, you and the other party must attend an initial session with a mediator. (The Family Court Commissioner
can make an exception to this requirement, if attending mediation would cause undue hardship or endanger
the health or safety of one of the parties.) The purpose of mediation is to work with a trained professional in
attempting to mutually solve the disagreement as it pertains to custody or periods of physical placement
(visitation). If an agreement is reached, the mediator will provide to the Court the mediated agreement and
court order incorporating the mediated agreement or you and the other party can put that agreement on the
record at the hearing.
Step Two: Appointment of a Guardian ad Litem
If mediation fails and you still have a disagreement over custody or periods of physical placement, the mediator
will so inform the Court and a guardian ad litem will be needed for your child(ren). The guardian ad litem is an
attorney that represents the best interest of the child(ren). Each party will be required to pay $650.00 as a
down payment toward the guardian ad litem fees, which are charged at the rate of $100.00 per hour. The
guardian ad litem will not begin his/her investigation on behalf of your child(ren) until the moving party (the
one that is bringing the Order to Show Cause) pays his or her $650.00. If the moving party fails to make that
payment, the Order to Show Cause will be dismissed.
g:\family\forms\instructions for filing a n order to show cause action -- May 7, 2026
Petitioner/Joint Petitioner A: ;:-_______ _
RespondenUJoint Petitioner B: ________ _
Enter the name of the
county in which the
STATE OF WISCONSIN, CIRCUIT COURT, MANITOWOC original case was filed. COUNTY
Check marriage or
IN RE THE D MARRIAGE D PATERNITY OF paternity. I f paternity.
enter initials of child.
Enter the name. address,
Petitioner/Joint Petitioner A and daytime phone
number of the petitioner or
joint petitioner from the Name (First, Middle and Last)
original case file.
Order To Show Cause
On the far right, mark the Current Mailing Address and to Change: box for the change(s) you
are requesting and enter o Legal Custody
the original case number. City State Zip Daytime phone number o Physical Placement
-vs- o Child Support
Respondent/Joint Petitioner B o Maintenance
Enter the name, address, o Arrears Payment
and daytime phone Name (First, Middle and last)
o Other: number of the respondent
or joint petitioner from the Current Mailing Address Case No.
original case file.
City State lip Daytime phone number
Check if the State of The State of Wsconsin (Child Support Agency) Wisconsin is a party Of
not. If you are unsure, you Dis
may call your local Child D is not a party to this action. Support Agency.
Enter the name of the The Declaration was filed on [Datel ,
palty you ""ant to appear
in court. IT [S ORDERED THAT appear in person at the following date and time:
Before Honorable Commissioner C. Luke LeFevre
Location Manitowoc County Courthouse, Room B-15
10 I 0 S. 8,h Street, Manitowoc, WI 54220
For Court Use Only: Date Time Da.m. D p.m.,
This section will be
completed by the court. or as soon as the matter may be heard, to show cause (give reasons) why the requests in the
declaration should not be granted.
If you do not appear as indicated, the court may proceed without you and grant the request
and/or issue a warrant for your arrest.
FA-4171V8, 09/24 Order To Show Cause and to Change: Custody/Physical PlacementlSupportiMaintenance/Arrears Payment §§767. 1 05, 767.451, and 767.59, WisconSin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 1 of2
Petitioner/Joint Petitioner A ;:-_______ _
Respondent/Joint Petitioner B:
IT IS FURTHER ORDERED:
• a copy of the Order to Show Cause and Declaration must be personally-served upon
all other parties at least five business days before the date of the hearing, unless
otherwise authorized by law. See the Service Packet (FA-5000) for more information.
• both parties must bring a fully completed, dated, and signed Financial Disclosure
Statement to court.
If you require reasonable accommodations due to a disability to participate in the court process, please call (920) 683-4030
prior to the scheduled court date. Please note that the court does not provide transportation.
FA-4171VB. 09f24 Order To Show Cause and to Change: CustodyfPhysical PlacemenVSupportiMaintenancefArrears Payment §§767.105. 767.451. and 767.59. Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 2 of 2
Petitioner/Joint Petitioner A: =-_______ _
RespondenUJoint Petitioner B: _______ _
Enter the name of the
county in which the
original case was filed.
Check 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.
Enter the name, address,
and daytime phone
number of the respondent
or joint petitioner from
the original case file.
Check if the State of
Wisconsin is a party or
not. If you are unsure,
you may call your local
Child Support Agency.
Check A if you are
requesting a change
to physical
placement, list the
children affected,
check 1-4 andlor 5
and/or 6 and
complete the
necessary
information.
Indicate if you have
or have not
attempted
Mediation. If you
have, indicate the
date of the
Mediation session.
Check B if you are
requesting a change
to legal custody, list
the children
affected, check I, 2,
or 3 and complete
the necessary
infonnation.
STATE OF WISCONSIN, CIRCUIT COURT,
MANITOWOC COUNTY
IN RE: THE D MARRIAGE D PATERNITY OF
Petitioner/Joint Petitioner A
Name (First, Middle and Last)
Current Mailing Address
City State Zip Daytime phone number Declaration to Show
-vs- Cause and to Change
Respondent/Joint Petitioner B D Legal Custody
D Physical Placement
Name (First, Middle and last) D Child Support
D Maintenance
Current Mailing Address D Arrears Payment
D Other:
City State Zip Daytime phone number
The State of Wisconsin (Child Support Agency) Case No. Dis
D is not a party to this action.
1. MODIFY as follows:
OA Physical Placement Order(s) (time with children) for the following children:
01) from primary physical placement with [Name of Parent]
to primary placement with [Name of Parent]
02) from shared placement to primary placement with [Name of Parent] ___
03) from primary placement to shared placement.
04) from the current shared placement schedule (if any) to a new shared placement
schedule.
The requested placement schedule for the changes in 1-4 above is as follows:
o See attached
o 5) to require placement with (Name of Parent) ___________ _
be 0 supervised. 0 unsupervised.
06) Other: -------------------r""'"---:-
o See attached
The other party and I 0 attempted mediation on [Date] --,------,--,----, ___ _
o have not attempted mediation for this issue.
OB. Legal Custody (decision making) for the following children:
o 1) to joint legal custody with both parents.
o 2) to sole legal custody with [Name of Parent] ___________ _
03) Other:
o See attached
FA.4171VA. 10/25 Declaration to Show Cause and to Change' §§ 767.105, 767.451, 767.59, Wisconsin Statutes
Custody/Physical PlacemenUSupportlMaintenance/Arrears Payment
This form shall not be modified. It may be supplemented with additional material.
Page 1 of 3
Petitioner/Joint Petitioner A: ;;-:-_______ _
RespondenUJoint Petitioner S"
Check C if you are
requesting changes
to support orders.
Check 1 if you are
requesting changes
to child support,
enter the amount
and frequency of
the current payment
and check whether
it includes a
deviation for health
insurance. In b.
check L 2, or 3.
Check A or B,
indicate deviation
information.
In D, enter any
other changes you
may have.
In 2, enter the date
the current court
order or judgment
was signed by a
court official.
DC CHANGE the following support orders as follows:
01) Child support
a. that is currently $ per that
01 does not include a deviation for health insurance or any other
reason.
02 does include a deviation of $
o upward o downward for health insurance.
b. To a new amount beginning to be paid by [Parent]
to IParent]
01 based on state child support standards determined by the court.
02. a new set amount of $ per
03 held open (no payment).
I request that this new amount
OA not include a deviation for health insurance or any other
reason.
DB include a deviation of $
o upward o downward as a cash contribution for
health insurance.
o 2) Maintenance (Spousal Support) that IS currently $ per to
o a. an amount beginning , 20 __ to be determined by
the court based on current income.
o b. a new set amount of $ per beginning __
__ -----:--,;--,-,--__ -::-::--_' 20 __ .
03) Arrears payment that is currently $ ____ per = __ ---,----,------:--,---to
o a. an amount beginning , 20 __ to be determined by
the court.
o b. a new set amount of $ ____ per __ beginning ____ _
20 __ .
I will be able to provide documentation to the court that supports my request.
NOTICE: Both parties must bring to court their fully completed, dated, and signed
Financial Disclosure Statement (FA-4139V) or Income and Expense Statement
(FA-4138V).
o D. Other change(s):
o See attached
2. The court order that I am asking to be modified was dated _______ _
3. This request is based on the following substantial change in circumstances that have occurred
since the entry of the prior court order in this case:
o A A child who was living with the other parent is now living with me.
DB. 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.
o C. The parties are no longer living together.
o D. There is not a placement schedule and the parties cannot agree.
o E. Employment or work shift of has changed.
o both parties has changed.
o F. Income or wages of has changed.
o both parties has changed.
o G. The availability or cost of health insurance has changed.
o H. The party to whom lowe maintenance has remarried.
o I. Other: ______________________ _
FA.4171VA, 10/25 Declaration to Show Cause and to Change· §§ 767.105, 767.451, 767.59, Wisconsin Statutes
Custody/Physical PlacementiSupportlMaintenance/Arrears Payment
This form shall not be modified. It may be supplemented with additional material.
Page 2 of 3
Petitioner/Joint Petitioner A: ;;,--_________ _
RespondenVJoint Petitioner B:
In 4. describe the
facts that justify the
change you want.
Attach additional
pages, if necessary.
4. This is a substantial change in circumstances because:
o See attached
If you require reasonable accommodations due to a disability to participate in the court process, please call: ____ _
prior to the scheduled court date_ Please note that the court does not provide transportation.
Provide a
declaration under
criminal penalty
of false swearing
in lieu of a sworn
statement.
You do not have
to take the
document to a
Notary Public if
you provide an
unsworn
declaration.
Sign this document WITHOUT a Notary Public.
I declare under the criminal penalty of false swearing
that the information I have provided is true and accurate.
~
Signature
Name Printed or Typed
Address
Email Address Telephone Number
Date State Bar No. (if any)
A copy of this Declaration to Show Cause and Order must be served upon all other parties at least five business days
before the date of the hearing. See the Service Packet (FA·5000) for more information.
FA-4171VA, 10125 Declaration to Show Cause and to Change: §§ 767.105, 767.451, 767.59. Wisconsin Statutes
CustodyfPhysical PlacemenVSupporVMaintenance/Arrears Payment
This form shall not be modified. It may be supplemented with additional material.
Page 3 of 3
I
Petitioner/Joint Petitioner A: ;oc-------
RespondenUJoint Petitioner B-
Enter the name of the county STATE OF WISCONSIN, CIRCUIT COURT,
in which this case is filed. MANITOWOC COUNTY
Petitioner/Joint Petitioner A
This form is used for
divorce, legal separation Name (First, Middle and last)
and paternity cases. Some
information may not apply
Current Mailing Address to your case.
Enter the name and address of City
the Petitioner/Joint Petitioner A.
State Zip Daytime phone number
and INCOME & EXPENSE
Respondent/Joint Petitioner B STATEMENT
t:.mer me name ana aaaress or
Name (First. Middle and Last) the Respondent/Joint Petitioner Case No. B.
Enter the case number and Current Mailing Address IV-D KIDS Case No.
child support IV-D KIDS
number, if known. City State Zip Daytime phone number
Failure by either party to complete and file this form as required will authorize the court to accept the statement of
the other party as the basis for its decisions. Deliberate failure to provide complete disclosure is a crime.
Attach additional pages if space is not sufficient.
1. PROOF OF INCOME
• Attach a statement reflecting income earned to date for the current year.
• Attach most recent W-2 Statement.
2. GENERAL INFORMATION
Name
Address
Address
City _______________ State ______ Zip ____ _
Phone [Day]
3. EMPLOYER INFORMATION
Name
Address
Address
City ______________ State ______ Zip ___ _
Phone [Day]
4. CURRENT MEMBERS OF YOUR HOUSEHOLD
Enter the name and relationship of all people actually living in your household at this time. Check yes or
no to identify if they contribute to payment of household expenses.
Name Relationship This person helps pay expenses
D I live alone Yes No
1. D D
2. D D
3. D D
4. D D
5. MONTHLY INCOME
Income from wages / salary is received: (check one) To calculate monthly gross income use the multiplier shown:
D weekly -multiply weekly income by 4.33 D every other week (bi-weekly) -multiply bi-weekly income by 2.17
D monthly D twice a month-multiply semi-monthly income by 2
FA-4138V, 12122 Income and Expense Statement §767.127. Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 1 of 3
Petitioner/Joint Petitioner A: ;;-______ _
Respondent/Joint Petitioner B'
MONTHLY GROSS INCOME
1. Gross monthly income (before taxes and deductions) from salary and wages, including
commissions, allowances and overtime.
2. Pensions, retirement funds and social security benefits received
3. Disability, Unemployment Insurance and/or public assistance funds received
4. Interest and Dividends received
5. Child Support and maintenance (spousal support) received
6. Rental payments received (from property you rent to others)
7. Bonuses received
B. Other sources of income received: (please specify)
9.
10, Total Gross Income (add lines 1-9)
MUN'MLY r "'UNO:>
~
11 . Number of tax CA<",,~du-,-,o claimed -
12. federal and state income tax, Social COo, "i" , and Medicare withholdings
13. ino, "~n~o
14. Other insurance (Life, i i , etc.)
15. Union or other dues
16. ", i , i fund
17. Child support or onn, '0~1 support payment nonll~tinno
18. Other dedurlinn~: (please i I)
19.
20.
21. Total Monthly DAn" , (add lines 12 - 20)
IVIUI'II ML Y NET INr.nIlllE I' : line 21 from line 10)
6. CURRENT MONTHLY HOUSEHOLD EXPENSES
Monthly Household Expenses
1. Rent/mortgage payment/property taxes/home or rent insurance (primary residence)
2. Food
3. Utilities (electricity, heat, water. sewage. trash)
4. Telephone (local, long distance & cellular)
5. Cable/Satellite and Internet Services
6. Insurance (life, health. accident. auto. liability, disability, excluding insurance that is paid through
payroll deductions)
7. Auto payments (loans/leases), auto expenses (gas. oil, repairs. maintenance), and
transportation (other than automobile)
8. Medical, dental and prescription drugexpenses (not covered by insurance)
9. Childcare (babysitting and day care)
10. Child support or spousal support payments (Exclude payments made through payroll
deductions)
11. Other expenses
Other Monthly installment payments:
12. Mortgage (other than primary mortgage)
13. Other vehicle payments (RV. boat, ATV)
14. Credit card debt (total minimum monthly payments)
15. Cour! ordered obligations
16. Student loans
17. Other personal loans
18.
TOTAL MONTHLY EXPENSES (Add lines 1-18)
FA-4138V, 12/22 Income and Expense Statement §767.127, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 2 of 3
Petitioner/Joint Petitioner A: 00--------
RespondenVJoint Petitioner B:
7. I 0 do 0 do not have assets (vehicles, real estate, personal property, stocks, retirement accounts, etc.)
with a total fair market value of $10,000 or more at this time.
8. DECLARATION: I declare under penalty of perjury that the above, including all attachments are
complete, true and correct.
Sign and print your
name.
Enter the date on which
you signed your name.
Note: This signature
does not need to be
notarized. Email Address
Date
Signature
Name Printed or Typed
Address
Telephone Number
State Bar No. (if any)
FA-4138V. 12/22 Income and Expense Statement §767.127, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 3 of3
This form is also available in Spanish and Hmong.
hltps:/Iwww.wicourts.gov/forms1/circuitlindex.htm
Este formulario esM disponible en espanol y hmong.
Daim ntawv no muaj txhais ua Ius Spanish thiab Ius Hmoob.
STATE OF WISCONSIN, CIRCUIT COURT, MANITOWOC COUNTY
D Amended
-vs- Petition for Waiver of Fees and Costs
Declaration of Indigency
Case No. _____ _
I DECLARE THAT:
Because of poverty, I am unable to pay D any filing and service fees, including the electronic filing fee, or
D , in this action,
proceeding, or appeal, or to give security for those fees, and request waiver of those fees.
The documents I want to file are included with this Petition.
Complete Section 1 if you receive aid from any of the programs listed.
If you do not receive aid, complete Section 2 only.
I Section 1.
I currently receive the following benefits andlor services:
D Supplemental security income. D Relief funded under §S9.S3(21), Wis. Stats. D Medical assistance.
D Food stamps/FoodShare. D Relief funded under public assistance.
D Benefits for veterans under §45.40 (1m) or 38 USC 501-562.
D Legal representation from the Public Defender's Office, civil legal services program or a volunteer attorney program based on
indigency.
Name of program: _--,-- _______________________________ _
D Other means-tested public assistance: ___________________________ _
My financial situation D has D has not changed since I became eligible for this program.
If you checked the "has" box, and such changes would make you ineligible for the program(s) if you applied today, you
must complete Section 2.
Section 2.
1. I Dam D am not married.
2. Dam D am not employed. Name of employer: ________________ _
3. I earn [Gross pay] $ D weekly. D every 2 weeks. D twice monthly. D monthly.
My take-home pay [after taxes and deductions] is $ ____ per pay period.
4. I receive gross monthly income totaling the amount of $ from
D Pension D Social security D Unemployment compensation
D Disability D Student loans/grants D Other: __________________ _
5. I have the following cash assets:
D Savings accounts: $ ______ _ D Cash: $ ______ _
D Checking accounts: $ ______ _ D Money owed me: $ _______ _
CV-410A. 09/24 Petition for Waiver of Fees and Costs - Declaration of Indigency §814.29, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 1 of 2
6.
7.
I have the following other assets:
o Vehicle-YrJMake: $ _____ 0 Household furnishings: $ ____ _
o Vehicle-YrJMake: $.-::-----:-- 0 Equity in real estate: $ ____ _
o Other individual assets valued over $200 each: ______________ $ ____ _
My household consists of myself and _______ others:
Full name: Relationship to me: ______ _
Full name: Relationship to me: ______ _
Full name: Relationship to me: ______ _
Full name: Relationship to me: ______ _
Full name: Relationship to me: ______ _
Underage 18 DYes
Underage 18 DYes
Under age 18 0 Yes
Under age 18 0 Yes
Under age 18 0 Yes
ONo
ONo
ONo
ONo
ONo
8. The other members of my household have gross monthly income totaling the amount of $ from
o Wages 0 Social security 0 Relief funded under public assistance 0 Food stamps/FoodShare
o Pension 0 Student loans/grants 0 Unemployment compensation 0 Supplemental security income
o Disability 0 Relief funded under §59.53(21), Wisconsin Statutes 0 Support/maintenance
o Other: _______________________________ _
9. I have the following debts: Amount: Monthly Payment:
a. Mortgage/Rent $ $
b Auto loan $ $
c. Credit cards $ $
d. Other: $ $
e. $ $
10. I have the following unusual expenses, other than ordinary living expenses:
CV-410A. 09/24 Petition for Waiver of Fees and Costs - Declaration of Indigency
I understand that if my financial situation changes, I
must notify the court immediately.
I declare under the criminal penalty of false swearing
that the information I have provided is true and
accurate.
Signature
Print or Type Name
Date of Birth
Address
Email Address Telephone Number
Date State Bar No. (if any)
§ 814,29, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 2 of 2
STATE OF WISCONSIN, CIRCUIT COURT, MANITOWOC COUNTY
-vs-
D Amended
Order on Petition for Waiver of
Fees and Costs
Case No.
This form is available in Spanish and Hmong. hltps:/Iwww.wicourts.gov/forms1/circuitJindex.htm
Este formu/ario esta disponible en espanol y hmong.
Daim ntawv no muaj txhais ua Ius Spanish thiab Ius Hmoob.
THE COURT FINDS AND ORDERS:
Upon reviewing the petition of [Name] -,--,- _______________________ _
for waiver of fees and costs, this petition is
o 1. GRANTED because the court finds the requestor is currently indigent. The action may be commenced or
defended without payment of filing fees, including the electronic filing fee. The sheriff shall serve all
necessary documents without payment of service fees. The requestor may be required to pay these fees
if the court later determines the requestor has the ability to pay.
o 2. GRANTED for waiver of The requestor may be required to pay fees if the
court later determines the requestor has the ability to pay.
o 3. DENIED because the court finds the requestor is not indigent, but is currently not able to pay filing or
service fees. This action may be filed by the Clerk and all necessary documents may be served by the
sheriff without prepayment of fees. Such fees must be paid no later than ___________ _
o 4. DENIED because the court finds
o requestor is not indigent. 0 the allegation of poverty to be untrue.
o requestor is a prisoner and is required to use form CV-438 or CV-440.
o requestor has not stated a meritorious claim, defense, or appeal upon which the court may grant relief:
[Brief explanation] _____________________________ _
o Other: ____________________________ _
DISTRIBUTION:
1. Clerk of Circuit Court
CV-41 DB, 01/21 Order on Petition of Waiver of FeesfCosts §814.29, Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
"Service" or "service of process" are the legal terms used to describe the act of giving notice
of a lawsuit or court hearing to another person. There are several different methods and very
specific time limits by which you must have the other party served. The type of service you
are required to use depends on the type of forms you are filing. If you do not have the other
party served properly (within the correct time limits and using the correct method), the court
cannot hear or decide your case.
Notice: This packet describes only the most common methods of service available for use.
Please seek legal assistance if you would like to explore additional/alternative
methods or the forms you are filing are not listed.
Court Self-Help Form Required Type Service Time Limits
of Service
Summons and Petition for Divorce! Legal Personal Within 90 Calendar days from the
Separation date the divorce/legal separation
(FA-41 04V/FA-41 05V) was filed
Order to Show Cause and Declaration Personal Not less than 5 Business days
for Temporary Order before the date of the Temporary
(FA-4128V /FA-4129V) hearing
Response & Counterclaim Mail Within 20 Calendar days after the
(FA-4113V) date of service
Order to Appear Personal Not less than 24 hours if the other
(FA-4142V) party lives within the county the
action is filed
Not less than 72 hours if the other
party does NOT live in the county
the action is filed, but in the State
of Wisconsin
Motion for and Notice of New (DeNovo) Personal (Contempt Not less than 5 Business days
Hearing matters) before the date of the hearing
(FA-4130V)
Mail (All other Not less than 8 Business days
matters) before the date of the hearing
Notice of Motion and Motion (Post Mail Not less than 8 Business days
Judgment)
( FA-4170V')
before the date of the hearing
Order to Show Cause (Post Judgment) Personal Not less than 5 Business days
(FA-4171V/FA-4172V) before the date of the hearinQ
Notice of Motion and Motion to Relocate Mail Not less than 8 Business days
with Minor Children before the date of the hearing
(FA-4178V)
Objection to Relocate with Minor children Mail Not less than 5 Business days
and Motion to change Placement and/or before the date of the hearing
Custody
(FA-4179V)
Subpoena Personal Not less than 10 Business days
(GF-126A) before the date of the hearing
Notice of Hearing and Motion to Enforce Personal Not less than 5 Business days
Physical Placement Order before the date of the hearing
(FA-609)
FA-SOOOV, 09/24 Service
Page 1 of 3
NOTE: If you are unable to serve the other party within the required time limits, you may
write a letter to the court requesting a different court date.
WARNING: Copies, NOT original documents, should only be given to the other party.
The originals (if in your possession) and proof of service need to be
returned to court after the other party has been served.
Personal Service
There are five basic ways to have the other party personally served:
1A. Admission of Service by the State of Wisconsin / Child Support Agency
If the State of Wisconsin is a party to the action, you must serve your local Child
Support Agency using the following steps below.
o Take a copy of the forms to be served and an Admission of Service form
(FA-4119V) to the Child Support Agency.
o Give the papers to a representative from the Child Support Agency and ask
him/her to "admit service". He/she will complete the bottom portion of the
Admission of Service form.
o Return the Admission of Service form to the Clerk of Courts Office as proof of
service (keep a copy for your records).
1 B. Admission of Service for the other party
You may give the documents to the other party and ask that he/she voluntarily
accept the papers from you. If the other party agrees to accept the documents, you
need to:
o Complete the caption of the Admission of Service form (FA-4119V).
o Have him/her complete and sign the bottom.
o Return the Admission of Service form and a set of the documents served, as
soon as possible to the Clerk of Courts. Remember to keep a copy for your
records.
If the other party will not voluntarily accept the papers from you, or you do
not wish to have contact with the other party, you must have the other party
served using one of the other methods described below.
2. Sheriff's Department
The Sheriffs Department, of the County in which the individual to be served
resides, may serve the other party. Proof of service and a set of the documents
which were served must be returned to court as soon as possible. Remember to
keep a copy for your records.
3. Private Process Server
You may make arrangements with a private process server to have the other
party personally served. Contact individual companies for fees and procedural
information. To find a private process server in your or the other party's area, you
may look under "Process Service" using a phone or internet directory or by going to
http://www.iprocessservers.com. Proof of service and a set of the documents which
were served must be returned to court as soon as possible. Remember to keep a
copy for your records.
FA-5000V. 09/24 Service
Page 2 of 3
4. Service by Friend or Relative
A friend or relative who is over 18, is a resident of Wisconsin, and is not a party to
the action can also serve the other party.
D You: complete the caption of the Declaration of Service form (FA-4120V).
D Friend or Relative: Gives a £Q.QY..of the paperwork to the other party.
D Friend or Relative: Completes the bottom portion of the Declaration of
Service and signs it.
D You: Return the Declaration of Service form and a set of the documents
served, as soon as possible to the Clerk of Courts. Remember to keep a copy
for your records.
LAST RESORT
Before attempting this last resort, you should consider seeking legal
assistance. There are specific and complicated rules that must be followed to
successfully serve a party by publication.
5. Service by Publication
Service by Publication is a last resort and can only be used if you failed to have
the other party served by one of the methods above. You have a responsibility to
make every effort to make personal service if possible, which includes gathering
reasonably available information from family and friends to try and determine the
other party's location.
The option of Service by Publication is only available to you if you can answer
yes to !ill of the following:
o You have tried personal service through the Sheriff's Department or a private
process server.
D You have given them as much information as possible to help them find the
other person.
D The Sheriff's Department or private process server cannot find the other person
after a diligent search.
D You have been given an Affidavit of Due Diligence/Not Found/ Attempted
Service by the Sheriff's Department or private process server stating that the
other party could not be found. Keep this affidavit.
The Service by Publication Packet (FA·S001V) is available to assist
individuals who are filing an action for divorce/legal separation.
Service by Mail
Serving documents on the other party by mail is allowed for certain types of forms. If service
by mail is allowed, you must:
D Mail copies of the documents to the other party.
D Sign the Declaration of Mailing (FA-4121V).
D Return the Declaration of Mailing and a set of the documents that were mailed
to the Court as soon as possible. Remember to keep a copy for your records.
FA-5000V. 09/24 Service
Page 3 of 3
MANITOWOC COUNTY
Sheriff - Daniel L. Hartwig
/n Partnership with the Community. Dedicated to Your Safety.
INFORMATION SHEET FOR CIVIL PROCESS/PAPER SERVICE
To the Petitioner/Submitter,
You are required to provide, to the best of your ability, the following information. It is understood that all
information may not be available to you; however, all information provided will assist in the service of your papers.
Court Date: ________ Court Time: ______ Serve by date: _______ _
INFORMATION ON THE PERSON TO BE SERVED:
Paper Service For:
Name _____________ Date of Birth _______ or Age __ _
Present Address: Home Phone # ~) ______ _
Temporary Address: Cell Phone # ~) c--------
Vehicle: ______ Color: _______ License Plate # ______ _
Place of Employment:
Address: ___________________________ _
Shift Hours: ___________ Work phone # ~) ______ _
Suggested Time to Serve Papers: ___________________ _
Comments: ___________________________ _
····COMPLETE FOR DOMESTIC ABUSE SERVICE ONLy····
Does the Respondent possess any firearms? DYes DNo How many? _____________ _
Where are the firearms stored? ________ ==----== ___________ --==_-==--
Must the Respondent be removed from the residence? DYes DNo 72 Hour no-contact in effect? DYes DNo
Person Requesting Service/Billing Information (MUST BE COMPLETED!)
/ understand that / will be billed for the service, unless / have provided an /ndigencv Order.
Your Name: Date of Birth: _______ _
(Last Name) (First Name) (M.I.)
Driver's License/Identification Number: ____________________ _
Mailing Address: __________________________ _
Telephone Number ~) Cell Phone Number: ~) ______ _
Email Address: ___________________________ _
There is no fee for seIVing Temporary Restraining Orders or Injunctions
1025 South 9th Street· Manitowoc. Wisconsin 54220 • Phone: (920) 683-4200
Jail Fax: (920) 683-4405 • Patrol Fax: (920) 683-4946 • Records Fax: (920) 683·4342
BOO-MTSO-Civi/ Process Info Sheet-Updated 3/2026
Fee Schedule
Civil Process: $60 minimum - $150 maximum per person. $60 deposit per person is
required. The $60 deposit includes one attempt or service. We may also charge $30
for each additional attempt or service. A maximum of 3 additional attempts can be
charged. Mileage is included and will not be charged separately. The $60 deposit
should be included when your papers are submitted for service.
Writs: $85 includes one hour of standby time. Additional standby time may be charged
at $85 an hour.
Sheriff's Sale: Posting $75 -- Sale $75 for a total of $150. Check should be sent with
original posting(s). A total of 4 copies of the sale should also be included.
Copies: $0.25 per printed side (black/white) - $0.50 per printed side (color)
Mailing Copies: Add $1.00 standard letter (fee may increase for larger packages)
Photos: 4" x 6" on photo paper - $3.50 each
CDIDVD/DVR - $10.00 each
8 I'z" x 11" photocopies of photos (Color $0.40 each)
Flash Drive - $15 each
All copies or photos over $5.00 must be paid in advance. A check should be made
payable and mailed to the Manitowoc County Sheriff's Office along with request.
Call (920) 683-4334 to request a quote on photo fees.
Reserve Deputy Security: Hourly charge, $45 per hour with a minimum charge of 4
hours ($180) per Reserve Deputy
Building Escort/Escort: $85 per squad per hour
Updated 04101124
Petitioner/Joint Petitioner A ;;-,-_________ _
RespondenUJoint Petitioner S·
Enter the name of the county STATE OF WISCONSIN, CIRCUIT COURT,
in which this case is filed. MANITOWOC COUNTY
Enter the name of the IN RE: THE D MARRIAGE D PATERNITY OF petitioner. If joint petitioners,
enter the name of
Petitioner/Joint Petitioner A. Petitioner/Joint Petitioner A
Enter the name of the Name (First. Middle and last)
respondent. If joint and petitioners, enter the name of Declaration of
Respondent! Respondent/Joint Petitioner B Service Joint Petitioner B.
Enter the case number. Name (First, Middle and Last) Case No.
,--___ -----,--,------,--------, I DECLARE THAT:
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 infonnation.
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.
Take Notice: You must
complete this task.
Provide a declaration under
criminal penalty of false
swearing in lieu of a sworn
statement.
You do not have to take the
document to a Notary Public
if you provide an unsworn
declaration.
I am an adult resident of Wisconsin, Illinois, Iowa, Michigan, or Minnesota.
I am not a party to this action.
On IDate] _____ ,' 20 __ at [Time] ___ 0 a.m. 0 p.m.
At [Address] ____________________________ _
I served a copy of the following documents:
o Authenticated Summons and Petition
o Order to Show Cause and Declaration for Temporary Order [Date] __ ,
20 __ .
o A blank Financial Disclosure Statement
o Requirement to attend parent education
o Order to Appear
I:8:l Other: Order to Show Cause and Declaration to Change:
o Other: Notice of Hearing and Motion to Enforce Physical Placement Order
o Other: Order to Show Cause and Declaration for Finding of Contempt
personally by delivering to and leaving these documents with the person served whom I
knowtobe _________________________ _
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.
Sign this document WITHOUT a Notary Public.
I declare under the criminal penalty of false swearing
that the information I have provided is true and
accurate.
Signature
Name Printed or Typed
Address
Email Address Telephone Number
Date State Bar No. (if any)
FA-4120V, 09/24 Declaration of Service §801.1 0, Wisconsin Statutes
This form shall not be modified, It may be supplemented with additional material.
I
Petitioner/Joint Petitioner A: ;;-:-_________ _
RespondenVJoint Petitioner B: _________ _
This form is available in Spanish.
https:/Iwww.wicourts.gov/forms1/circuit/index.htm
Este formu/ario esM disponib/e en espano/.
Enter the name of the
county in which this case
is filed.
Enter the name of the
petitioner. If joint
petitioners, enter the name
of Petitioner/Joint
Petitioner A.
Enter the name of the
respondent. If joint
petitioners, enter the name
of Respondent/Joint
Petitioner B.
Enter the case number.
Check the box for each
document that is being
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.
The party who is
voluntarily accepting the
documents must sign and
print their name,
They must enter the date
on which the Admission
was signed.
Note: This signature does
not need to be notarized.
STATE OF WISCONSIN, CIRCUIT COURT,
MANITOWOC COUNTY
IN RE THE MARRIAGE OF
Petitioner/Joint Petitioner A
Name (First, Middle and Last)
and
Respondent/Joint Petitioner B Admission of Service
Name (First. Middle and Last) Case No.
On IDate] ______ I received a copy of the following documents:
D Authenticated Summons and Petition
D Order to Show Cause and Declaration for Temporary Order IDated] ____ _
D A blank Financial Disclosure Statement
D Proposed Marital Settlement Agreement/Order [Dated] ________ _
D Order to Appear [Dated] _______ _
D Motion/Order to Show Cause for Contempt [Dated] __________ _
C8J Motion/Order to Show Cause to Change: ____________ _
[Dated] ______ _
D Requirement to attend parent education
D Other: Notice of Hearing and Motion to Enforce Physical Placement Order
D Other: ______________________ _
D Other: ______________________ _
Signature
Name Printed or Typed
Address
Email Address Telephone Number
Date State Bar No. (if any)
FA-4119V 09/24 Admission of Service §801.1 O(4)(c). Wisconsin Statutes
, This form shall not be modified. It may be supplemented with additional material.
Source: Manitowoc County website. First collected Oct 13, 2026.