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DEPARTMENT OF HEALTH SERVICES Division of Public Health F00123 LVR (Rev. 12/11) STATE OF WISCONSIN Chapter 69.21 Wis.Stats. Page 1 of 2WISCONSIN DECLARATION OF DOMESTIC PARTNERSHIP APPLICATION (for
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What is PENALTIES:Any person who willfully and knowingly makes a false application for a domestic partnership shall be fined not more than $1,000 or imprisoned not more than 90 days, or both, per s Form?

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Penalties for any person who willfully commit a violation may include fines or imprisonment.
Individuals or entities who have committed a willful violation are required to file penaltiesany person who willfully.
To fill out penaltiesany person who willfully, the individual or entity must provide detailed information about the violation and any mitigating factors.
The purpose of penaltiesany person who willfully is to deter individuals or entities from committing willful violations and to ensure compliance with regulations.
The report on penaltiesany person who willfully must include details of the violation, any mitigating factors, and any corrective actions taken.
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