STATE OF WISCONSIN

CIRCUIT COURT – [COUNTY] COUNTY

[BRANCH DESIGNATION]

[PLAINTIFF NAME], individually and as Personal Representative
of the Estate of [DECEDENT NAME],
Plaintiff,
v. Case No. ___
[DEFENDANT NAME(S)],
Defendant(s).

VERIFIED COMPLAINT

(Wrongful Death and Survival Action)

[// GUIDANCE: This template is drafted for a negligence-based wrongful-death suit.
Adapt liability theories (e.g., strict liability, medical malpractice, products liability) and add additional counts as appropriate.]

TABLE OF CONTENTS

1. Parties, Capacity, and Service .............................................................. ¶ 1
2. Jurisdiction & Venue ......................................................................... ¶ 6
3. Factual Allegations .......................................................................... ¶ 11
4. Count I – Wrongful Death (Wis. Stat. §§ 895.03, 895.04) ................. ¶ 20
5. Count II – Survival Claim (Wis. Stat. §§ 895.01, 895.04) ................. ¶ 30
6. Damages ............................................................................................ ¶ 36
7. Demand for Jury Trial .................................................................. ¶ 42
8. Prayer for Relief ............................................................................. ¶ 44
9. Verification, Signature Block & Certifications ............................ ¶ 49

[// GUIDANCE: Paragraph numbers auto-update in most word-processing programs.
Cross-check before filing.]

DEFINITIONS

For purposes of this Complaint, the following capitalized terms shall have the meanings set forth below:

A. “Decedent” means [DECEDENT NAME], who died on [DATE OF DEATH].
B. “Estate” means the probate estate of the Decedent, pending in [COUNTY] County Case No. __, for which Plaintiff serves as duly appointed Personal Representative.
C. “Statutory Beneficiaries” means those individuals designated under Wis. Stat. § 895.04(2) (2023) who are entitled to recover wrongful-death damages.
D. “Defendant” or “Defendants” means [DEFENDANT NAME(S)], together with any agents, servants, or employees whose acts or omissions are alleged herein.

1. PARTIES, CAPACITY, AND SERVICE

1. Plaintiff [PLAINTIFF NAME] (“Plaintiff”) is an adult resident of the State of Wisconsin, residing at [ADDRESS], and is the duly appointed Personal Representative of the Estate.
2. Decedent died intestate/testate on [DATE] as a direct and proximate result of Defendant’s wrongful acts and omissions described herein.
3. The Statutory Beneficiaries include:
   a. [SPOUSE/DOMESTIC PARTNER NAME], spouse/domestic partner;
   b. [CHILD NAME(S)], minor/adult child(ren); and
   c. Any other beneficiaries to be identified pursuant to Wis. Stat. § 895.04(2).
4. Defendant [DEFENDANT NAME] is a [corporation/LLC/individual] organized under the laws of [STATE] with its principal place of business at [ADDRESS] and may be served through its registered agent, [AGENT NAME & ADDRESS].
5. All parties have the requisite capacity to sue and be sued.

2. JURISDICTION & VENUE

6. This Court has subject-matter jurisdiction under Wis. Stat. § 895.03 (2023) and Wis. Stat. § 801.04 (2023).
7. Personal jurisdiction exists because Defendant [is domiciled in/does substantial business in/committed tortious acts within] Wisconsin.
8. Venue is proper in [COUNTY] County under Wis. Stat. § 801.50 (2023) because the events giving rise to this action occurred here and/or Defendant resides or conducts business here.
9. The amount in controversy exceeds the jurisdictional minimum of this Court.
10. All statutory conditions precedent to bringing this action have been satisfied, waived, or excused.

3. FACTUAL ALLEGATIONS

11. On [DATE], at approximately [TIME], Decedent was [brief description of activity—e.g., driving northbound on Hwy XX, undergoing surgery at Hospital Y, using Product Z].
12. Defendant owed Decedent a duty of reasonable care [describe source of duty—statutory, common-law, contractual].
13. Defendant breached that duty by [specific acts/omissions].
14. As a direct and proximate result of Defendant’s breach, Decedent sustained severe injuries, conscious pain and suffering, and ultimately death on [DATE OF DEATH].
15. Decedent incurred medical expenses in the amount of approximately $[AMOUNT].
16. Funeral and burial expenses totaled approximately $[AMOUNT].
17. Decedent was [AGE] years old and had a normal life expectancy of [NUMBER] additional years.
18. Prior to death, Decedent provided financial support, society, and companionship to the Statutory Beneficiaries.
19. Plaintiff incorporates paragraphs 1–18 as though fully set forth herein.

4. COUNT I – WRONGFUL DEATH

(Against All Defendants)
(Wis. Stat. §§ 895.03, 895.04)

20. Plaintiff realleges paragraphs 1–19.
21. Defendant’s negligent acts and omissions constitute a “wrongful act, neglect or default” within the meaning of Wis. Stat. § 895.03 (2023).
22. Pursuant to Wis. Stat. § 895.04(1) (2023), Plaintiff, as Personal Representative, is authorized to maintain this action.
23. As a direct and proximate result of Defendant’s negligence, Decedent died, causing pecuniary injury to the Statutory Beneficiaries.
24. Recoverable wrongful-death damages include but are not limited to:
    a. Funeral and burial expenses pursuant to Wis. Stat. § 895.04(4);
    b. Loss of society and companionship, subject to the statutory cap of $[350,000/500,000] (adult/minor decedent) per Wis. Stat. § 895.04(4); and
    c. Pecuniary damages, including loss of support, services, care, and guidance.
25. Plaintiff demands judgment accordingly.

5. COUNT II – SURVIVAL CLAIM

(Against All Defendants)
(Wis. Stat. §§ 895.01, 895.04)

30. Plaintiff realleges paragraphs 1–29.
31. Under Wis. Stat. § 895.01 (2023), Decedent’s cause of action for personal injuries, conscious pain, and suffering survived his/her death and is now vested in the Estate.
32. Prior to death, Decedent endured conscious pain and suffering, loss of enjoyment of life, and emotional distress.
33. Plaintiff seeks all damages recoverable by the Estate under Wisconsin law, including but not limited to:
    a. Pre-death medical expenses;
    b. Pre-death lost earnings;
    c. Conscious pain and suffering; and
    d. Any other lawful damages.
34. Plaintiff further seeks prejudgment interest and costs allowable by law.
35. Plaintiff demands judgment accordingly.

6. DAMAGES

36. Total damages sought exceed the minimum jurisdictional amount and are believed to be in excess of $[AMOUNT], exclusive of costs, interest, and statutory caps where applicable.
37. Plaintiff reserves the right to amend to conform to proof at trial.
38. Any award for loss of society and companionship shall not exceed the statutory limit set forth in Wis. Stat. § 895.04(4).
39. Plaintiff seeks punitive damages if discovery establishes Defendant’s willful, wanton, or reckless conduct as defined under Wisconsin law.

[// GUIDANCE: Punitive damages require clear and convincing evidence under Wis. Stat. § 895.043. Add or delete as facts dictate.]

40. Plaintiff also seeks taxable costs and disbursements, together with prejudgment and post-judgment interest as allowed by law.
41. All damages are sought jointly and severally against all Defendants unless otherwise ordered.

7. DEMAND FOR JURY TRIAL

42. Pursuant to Article I, Section 5 of the Wisconsin Constitution and Wis. Stat. § 805.01 (2023), Plaintiff demands a trial by a jury of twelve (12) persons on all triable issues.

8. PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully requests that the Court enter judgment in Plaintiff’s favor and against Defendant(s) as follows:

a. For compensatory damages in an amount to be determined at trial, within statutory limits;
b. For punitive damages as allowed by Wis. Stat. § 895.043, if proven;
c. For prejudgment and post-judgment interest as allowed by law;
d. For Plaintiff’s taxable costs, disbursements, and attorney fees as permitted;
e. For such other and further relief as the Court deems just and proper.

9. VERIFICATION, SIGNATURE BLOCK & CERTIFICATIONS

[PLAINTIFF NAME]
Personal Representative of the Estate of [DECEDENT NAME]
By Counsel:

[ATTORNEY NAME]
State Bar No. ____
[FIRM NAME]
[ADDRESS]
[PHONE] | [EMAIL]

DATED: ____

Verification

I, [PLAINTIFF NAME], verify under penalty of perjury that the factual allegations contained in the foregoing Complaint are true and correct to the best of my knowledge, information, and belief.

[PLAINTIFF NAME]

Wis. Stat. § 802.05 Certification

The undersigned counsel certifies that, to the best of his/her knowledge, information, and belief, formed after reasonable inquiry, this pleading is well-grounded in fact and warranted by existing law or a good-faith argument for the extension, modification, or reversal of existing law.

[ATTORNEY NAME]

[// GUIDANCE: Notarization is generally not required for Wisconsin complaints unless local rules demand verification under oath. Confirm with county clerk.]

OPTIONAL ADDENDA

1. Proposed Summons (Wis. Stat. § 801.095).
2. Probate Letters of Authority appointing Plaintiff as Personal Representative.
3. Expert Affidavit (if required under medical-malpractice or professional-negligence statutes).

[// GUIDANCE: Attach supporting documents as exhibits and label consecutively (Ex. A, Ex. B, etc.).]

END OF DOCUMENT