Order To Show Cause and Affidavit for Finding of

PRINT in BLACK ink
Enter the name of the
county in which the
original case was filed.
Check paternity or
marriage. 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.
For Official Use
STATE OF WISCONSIN, CIRCUIT COURT,
COUNTY
In re the
Marriage
Paternity of
,
Petitioner/Joint Petitioner:
First name
Middle name
Last name
Current Mailing Address
On the far right, enter the
original case number.
City
State
Zip
Daytime phone number
Vs.
Order To Show Cause
and Affidavit for Finding of
Contempt
Respondent/Joint Petitioner:
nter the name, address,
and daytime phone
number of the respondent
or joint petitioner from the
original case file.
First name
Enter the name of the
party you want to appear
in court.
For Court Use Only:
This section will be
completed by the court.
Last name
Case No.
Current Mailing Address
City
Check if the State of
Wisconsin is a party or
not. If you are unsure,
you may call your local
Child Support Agency.
Middle name
State
Zip
Daytime phone number
The State of Wisconsin (Child Support Agency)
is
is not a party to this action.
ORDER TO SHOW CAUSE
Upon the attached Affidavit, IT IS ORDERED THAT:
appear in person at the following date and time:
Before:
Location:
Date:
a.m./p.m. , or as soon as the matter may be heard,
Time:
To show cause why YOU should not be found in contempt of court as requested in the attached
affidavit. If you do not appear as indicated, the court may hold the hearing without you and grant
the request, including issuing an order to have you arrested and committed to the county jail.
You also have a right to be represented by an attorney at this hearing. Unless good cause is
shown, failure to appear without an attorney will be deemed a waiver of that right.
IT IS FURTHER ORDERED that:
• A copy of this order and affidavit be personally served upon all other parties at least 5
business days before the date of the hearing.
• Both parties bring to court a fully completed, dated, and signed Financial
Disclosure Statement and all required attachments.
BY THE COURT:
For Court Use Only
Circuit Court Judge/Circuit Court Commissioner
Print or Type Name
Date
FA-4172Pro Se 08/06 Order to Show Cause and Affidavit for Finding of Contempt
§§767.32, 767.325 , Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 1 of 2
PRINT in BLACK ink
AFFIDAVIT FOR FINDING OF CONTEMPT
Check all those
categories for which you
believe the other party is
in contempt. If other,
mark the box and write
for what you believe the
other party is in
contempt.
IF the issues are related
to legal custody or
physical placement of a
child, the Notice of
Hearing and Petition to
Enforce Physical
Placement is available.
Enter the date the current
court order or judgment
was signed by a court
official.
1. The other party was court ordered to do the following and has failed to do so:
Pay child support in the amount of $
per
.
Pay maintenance (spousal support) in the amount of $
per
.
Pay family support in the amount of $
per
.
Pay uninsured medical bills in the total amount of $
.
I will bring copies of the unpaid bills to the hearing.
Return property that was awarded to me.
Sign/complete final documentation (Quit Claim Deed, QDRO, WI Real Estate Transfer
Return, vehicle titles, etc.).
Pay debts that he/she was ordered to pay.
Pay the amount of $
to equalize the property settlement.
Allow me to claim the children as tax exemptions as ordered.
Provide medical insurance cards and/or other medical records.
Pay transportation expenses related to placement in the total amount of $
Other:
Other:
Other:
Other:
Other:
2. The court order that I am asking to be enforced was dated:
.
3. The facts supporting my reasons for believing that the other party is in contempt are as
follows:
Enter the facts that
support your claim. If
you need additional
space, mark the box and
attach the sheets.
See Attached
STOP!
Take this document to a
Notary Public BEFORE
you sign it.
After you have been
sworn by a Notary Public,
sign and print your name
and date the document in
front of the Notary Public.
If you need help in this matter
because of a disability, please
call:
Signature
Name Printed or Typed
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:
A copy of this Order to Show Cause and Affidavit must be served upon all other parties at least
5 business days before the date of the hearing. See Service Packet for more information.
FA-4172Pro Se 08/06 Order to Show Cause and Affidavit for Finding of Contempt
§§767.32, 767.325 , Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
Page 2 of 2