Confidential Petition Addendum {GF-179}

Petitioner/Joint Petitioner A: Respondent/Joint Petitioner B: GF-179, 05/17 Confidential Petition Addendum 247247767.215(5), and 767.54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Enter the name of the county in which this case is filed. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY This form is used for family and paternity case types. Some information may not apply to your case. Petitioner /Joint Petitioner A : Name (First, Middle and Last) Respondent /Joint Petitioner B : N ame (First, Middle and Last) Confidential Petition Addendum Enter the case number and child support IV - D KIDS number, if known. Case No. IV - D KIDS Case No. Enter the name, date of birth [month, day, year], and social security number of each party. 1. Parties A . Petitioner/Joint Petitioner A /Alleged Parent : Date of Birth: SS#: Phone No. B. Respondent/Joint Petitioner B/Alleged Parent : Date of Birth: SS#: Phone No. C. Other party : (I f any) Date of Birth: SS#: Phone No. See attached Enter the na me, date of birth [month, day, year], and social security number of each minor child. If there are no minor children, check none. Attach additional pages if necessary. 2. Minor Child ( ren ) that we have together A. The minor child ( ren ) of the other party and me (born or adopted) before or during the marriage/relationship are: None Name of Minor Child Date of Birth SS# See attached B. Other Minor Child ( ren ) If this is a divorce or legal separation, list other minor child ( ren ) born to either party during this marriage, but not fathered by the other party : None Name of Minor Child Date of Birth SS# Parent See attached The party(s) filing this addendum must sign and print your name and date the document. Signature Print or Type Name Date Signature Print or Type Name Date American LegalNet, Inc. www.FormsWorkFlow.com