Fill and Sign the Agreement Terminate Form

Agreement to Terminate Cohabitation Agreement made on       , between       (Date) (Name of First Cohabitant) of       , referred to herein as First Cohabitant; and (Street Address, City, County, State, Zip Code)       of       , (Name of Second Cohabitant) (Street Address, City, County, State, Zip Code) referred to herein as Second Cohabitant. For and in consideration of the mutual covenants contained in this Agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Parties agree as follows: 1. The parties have resided together without establishing a statutory marriage relationship since       . (Date) 2. The parties have       of children who are listed as follows: (Number)       . (List Name of Each Child and said Child’s Date of Birth) 3. No further children are contemplated. 4. The parties shall henceforth live separately and without interference from one another. 5. The parties waive any legal, equitable, or statutory rights which are not set forth herein. 6. Other than those rights and obligations which are set forth herein, the parties mutually release one another from any and all claims, demands, contracts, statutory rights, or other obligations. 7. The parties waive any and all rights to participate or share in the estate of one another. Each party waives the right to act as the executor of the will or probate estate of the other party to this agreement. This waiver shall not apply as to any obligations set forth in this agreement, and either party may present a claim as a creditor or party in interest in the other's estate to the extent that those rights arise and are derived from this agreement. 8. The parties have incurred the following joint debts:       . (List) 9. First Cohabitant shall be solely responsible for the following debts:       . (List) 10. Second Cohabitant shall be solely responsible for the following debts:       . (List) 11. As to debts which either party undertakes sole responsibility, said party shall indemnify and hold the other party harmless from any and all claims related to such debt. Agreement to Terminate Cohabitation Page 1 of 3 12. The following disposition is made of the joint debts of the parties:       . (Describe) 13. Each party shall duly and promptly discharge his or her respective portion of each debt stated above. 14. Each party shall be liable in contribution to the other for any amounts paid under compulsions which are in excess of the agreed shares stated above. 15. The following property is the separate property of First Cohabitant, and Second Cohabitant waives any and all claims to such property:       . (Describe) 16. First Cohabitant shall pay and hold Second Cohabitant harmless from any liabilities or claims related to the separate property above. 17. The following property is the separate property of Second Cohabitant, and First Cohabitant waives any and all claims to such property:       . (Describe) 18. Second Cohabitant shall pay and hold First Cohabitant harmless from any liabilities or claims related to the separate property above. 19. The following property is the joint property of the parties:       . (Describe) 20. The following disposition shall be made of the jointly-held property:       . (Describe) 21. The parties warrant to one another that all jointly-held property has been disclosed. 22. First Cohabitant and Second Cohabitant shall have joint custody of the children of this relationship. Any major decision regarding the welfare of the children shall be made by consensus. 23. Support for the children shall be paid as follows:       . (Describe) 24. The day to day custody and visitation of the children shall be decided upon by consensus of the parties. 25. The parties recognize that the Courts shall have the right to modify these arrangements upon appropriate petitions. 26. The parties shall take income tax exemptions for the children as follows:       . (Describe) 27. The parties herein are making a disposition of jointly-held property between co-owners and that the transactions herein are not sales for the purpose of income tax. The parties agree that the basis for tax purposes of the items is not changed by these transactions. Agreement to Terminate Cohabitation Page 2 of 3 28. This Agreement contains the entire agreement between the parties, and this agreement may only be altered in writing executed by the parties hereto. 29. Each party has had a full opportunity to consult with independent counsel regarding this agreement. 30. This Agreement was jointly drafted by the parties. 31. Governing Law. This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of       . (Name of State) 32. Mandatory Arbitration . Any dispute under this Agreement shall be required to be resolved by binding arbitration of the parties hereto. If the parties cannot agree on an arbitrator, each party shall select one arbitrator and both arbitrators shall then select a third. The third arbitrator so selected shall arbitrate said dispute. The arbitration shall be governed by the rules of the American Arbitration Association then in force and effect. 33. In the event of any reconciliation of the parties, this agreement shall remain in full force and effect unless canceled or amended in writing. WITNESS our signatures as of the day and date first above stated. By: By: (Signature of First Cohabitant) (Signature of Second Cohabitant)             (P rinted Name of First Cohabitant) (P rinted Name Second Cohabitant) Agreement to Terminate Cohabitation Page 3 of 3