Fill and Sign the Done Freely and Voluntarily Form

NON-MARITAL COHABITATION AGREEMENT How to complete this document. Option 1: This document is in Microsoft Word format. You should be able to see fields for completion that are gray shaded areas. If you do not, go on your toolbar to “View”, “Toolbars” and check “Forms”. You should now be able to see the fields. If you do not see a gray box here ( ) you do not have forms checked in the toolbars. Next, read the document and make any changes desired to the text of the document that are not fields. Next, click on the lock in the forms toolbar, or go to “tools”, “protect document” and check “forms” then OK. This will lock the document for completion. You may now complete all the fields on your computer and save the completed form. WARNING: If you lock the document and then complete the fields and then unlock you will lose the information you completed in the fields. Option 2: Make sure you can see the fields. See option 1. Revise the document text. Then click on each field to be completed and type the information you desire. This will replace the field with the information and the field will no longer exist. - 1 - NON-MARITAL COHABITATION AGREEMENT READ BEFORE SIGNING: IMPORTANT NOTICE: EACH PARTY TO THIS AGREEMENT AGREES THAT THEY HAVE HAD AN OPPORTUNITY TO CONSULT WITH AN ATTORNEY OF THEIR CHOICE LICENSED TO PRACTICE LAW IN THE IR STATE OF RESIDENCE (NOT THE SAME ATTORNEY) AND THAT EACH PARTY HAS FULLY READ, UNDERSTAND AND AGREE TO THE TERMS OF THIS AGREE MENT. EACH PARTY FURTHER AGREES THAT THEY ARE NOT ACTING UNDER DURESS OR UNDUE INFLUENCE IN EXECUTING THIS AGREEMENT AND THAT EXECUTION OF SAME IS DONE FREELY AND VOLUNTARILY. THIS AGREEMENT, made this ___ day of __________________ , 20____, between ___________________________, of ___________________________ __________________, ("First Party”), and ___________________________ , of ___________________________ , __________________ , ("Second Party”), WHEREAS, the parties now reside together or are in contemplation of establi shing a residence together; and WHEREAS, the parties desire to execute this agreement in contemplati on of said cohabitation, or in consideration of continued cohabitation; and WHEREAS, the parties desire to enter into an agreement regarding certain prope rties, responsibilities, duties and obligations including, but not limited to, any interes t, present or future, legal or equitable, vested or contingent, in real or personal property, including income a nd earnings; and WHEREAS, the parties have furnished each other with a financial stateme nt which each party acknowledges is a full and complete disclosure of substantially all of the real and personal property now owned by him or her. Each party acknowledges that the values are an esti mate by him or her of the approximate present value thereof, all of which property is now and sha ll continue to be separate properties of the respective parties, copies of said financial statements are attached hereto as Exhibits “A” and “B” respectively; and WHEREAS, the parties desire to express in writing their agreement that, except as hereinafter specifically provided, their cohabitation shall not in any way change t heir rights, or the rights of their heirs (exclusive of the parties) or of their devisees or legatee s, in the real and personal property owned or hereafter acquired by each of the parties and that said rights shall be governed by the terms of this agreement. NOW, THEREFORE, in consideration of the parties and of their mutual promise s and agreements, they agree one with the other as follows: 1. Previously Owned Property: Except as otherwise provided herein, each of the parties shall have full control of the property, real, personal and mixed, wherever loca ted, of the other and shall have and hereby is given the right to lease, sell, convey, mortgage or otherwise - 2 - dispose of the same and receive all monies, rents, issues, income and profits thereof without any restrictions whatever and without interference from the other party. Further, both partie s waive any rights which may be established by cohabitation, except as expressly provided for in this agreement. Property acquired by either party prior to execution of this agreement that shall he reafter be considered property of both parties and therefore joint property is as follows: . 2. Debts: The parties agree in reference to debts as follows: (a) As to Debts of either party incurred prior to cohabitation: To be mutually responsible for said debts. To be responsible for their individual debts only. To jointly be responsible for only the following debts: (b) As to debts incurred by the parties after cohabitation: Such debts shall be the responsibility of the part incurring same. Both parties shall be responsible for the debts of both parties. The debts shal l be considered joint. The parties shall only be jointly responsible for joint debts and each party sha ll be responsible for their own individual debts. 3. Wills: The parties have each executed a Last Will and Testament, copies of which are attached hereto as Exhibits “C” and “D”. The parties agree that these Wills are in conformity with the provisions of this agreement and as consideration for this agreement, each pa rty does hereby waive any and all objection to the terms of the said Last Will and Te stament of the other and each party agrees not to contest or renounce the terms of thereof. Likewise, each party agrees not to contest or renounce any future Wills or Codicils, which are in conformity with the terms of this agreement. The parties shall not change their existing Will, if any, or make a new w ill at this time, but any new Will executed shall be in conformance with the provisions of this agreement. 4. Evidence of Agreement. The fact that either party (without being obligated to do so) may give, devise or bequeath to the other party property or an interest therein, or othe rwise confer rights or powers on the other party, in trust or by gift or will, shall not be const rued as a waiver of any provision hereof or as evidence that there is or was an agreement or understanding between the parties other than as specifically expressed herein. 5. Execution of Documents: Each party agrees, on behalf of himself or herself and of his or her heirs, executors, administrators and assigns, that he, she or they, at the request of the other party or the latter's heirs, executors, administrators and assigns (but at the cost of the other party or his or her heirs, executors, administrators, and assigns), will make, do, execute, a cknowledge and deliver any and all such further or other acts, deeds and instruments as shall be appropriate, - 3 - necessary or desirable to carry in effect the intent, purpose and provisions of this agreement without question or delay, except that neither party shall be obliged to sign any mortgage, not e, bond or other instrument which may subject him or her, or his or her estate and property, to pe rsonal liability. 6. Property and Disposition of Property: Assets acquired by the parties during cohabitation shall be acquired in the name or names of the parties who will own same. All personal property located in the residence of the parties shall be considered equally ow ned by the parties except items owned prior to cohabitation, or items acquired by inheritance or gift to only one party. Unless owned in both names all property shall be considered the property of the part y in whose name the property is titled. In selling, assigning, granting, releasing, conveying or otherw ise dealing with the property of either party, the property of one party shall not be sold, assigned, rel eased, conveyed, or otherwise disposed of without the express written consent of the property’s owner. 7. Expenses: The parties agree to share the following expenses as provided below. “Both” means that the expenses will be shared equally. First Party Second Party Both Housing Telephone Residential Gas Electricity Cable Internet Groceries Auto Payments (First Party) Auto Payments (Second Party) Health Insurance Dental Insurance Health Expense Dental Expense Other: The parties shall be solely liable or accountable for the following expenses which t hey may incur or be otherwise accountable for: Child support for any children not of this relationship, child ca re for any child not of this relationship, magazine subscriptions, health club memberships, food ea ten outside the residence when other cohabitant party is not present, food for any third party, medi cal - 4 - care for any third party, dental care for any third party, traffic fines and costs, tax penalties and liabilities, entertainment expenses for any third party, or entertainment expenses whe n both cohabitants are not present, legal expenses, personal hygiene or personal care expenses includi ng but not limited to beauty shops, barbershops, health spas, nail care salons, private nursing care, personal trainers, therapists, gambling expenses, alcoholic beverages, tobacco products, toiletry item s, vacation expenses when other cohabitant is not present, any expense of guest of other cohabitant , any travel expense including but not limited to travel tickets, motels, hotels, rent al cars, charge upon any credit card, bank loans not jointly signed, gifts, or tips for any expenditure, care, maintena nce or entertainment for any friend or relative. 8. Bank Accounts: The parties agree to the following: ( Check all that apply). The parties shall deposit earnings and other funds in joint checking and/or savings accounts, for disposition at will by either party. E ach party shall retain his or her own earnings and other funds in his or her own individual savings, checking, or other account, for disposition at will, except for funds needed for household expenses, if so indicated in this agreement. The parties shall maintain a joint checking account for household expenses such as rent, food, household supplies, and utilities. The parties shall contribute to this ac count the amounts necessary to cover the household expenses. 9. Health Insurance. Both parties hereby agree that: Both parties will make every reasonable effort to include the other party on any health insurance that might be provided by an employer, equally dividing the cost of sa id health insurance. The parties will be individually responsible for their own health insurance. 10. Life Insurance. The parties agree that: The parties will make every reasonable effort to name each other as the beneficiary of any life insurance policies held. The parties will not name each other as beneficiaries for any life insurance policies held. 11. Health Care Decisions. The parties agree that: Each party shall execute a durable power of attorney for the purposes of health care decisions in favor of the other party. The parties will not be entitled to make health care decisions for one - 5 - another. 12. Post-Cohabitation Support: Regardless of the length of the period of cohabitation, neither party hereto shall be entitled to any claim for maintenance, alim ony, palimony or any other payment based on a claim that the cohabitation inferred, granted, created, or inferre d that said right or claim would be created by said cohabitation, except as provided herein. Further both of t he parties hereto, hereby agree to indemnity and hold harmless, the other party from any such claim, and against any court costs or attorney fees associated with any claim in contravention of this agreement. The parties agree that in the event of the dissolution of the relationship and the termination of cohabitation: Neither party shall have any obligation to support the other party, either during the relationship or in the event that the relationship terminates. The parties agree that in the event of a separation and an end to cohabitation of the parties, shall pay to , the amount of $ per month for a period of months. 13. Post-Cohabitation Provisions: The parties further agree that in the event of separation and the end of cohabitation, the following additional provisions shall apply notwithstanding the other provisions of this agreement: (Check any that apply). , shall be entitled to receive the following property: . , shall be entitled to receive the following property: . The following property shall be sold and the proceeds, less expenses divided equally between the parties: [none or list property]: . 14. Controlling Law: This agreement shall be controlled, construed and given effect by and under the laws of the State of Nebraska. It is the intent of the parties that the Agreement be enforced to the fullest extent permissible under applicable law s and public policies. The invalidity, illegality, or unenforceability of any particular provision of this Agree ment shall not affect the other provisions, and this Agreement shall be construed in all respec ts as if such invalid, illegal, or unenforceable provision had been omitted. 15. Entire Agreement: This Agreement constitutes the entire agreement between the parties pertaining to its subject matter and it supersedes all prior conte mporaneous agreements, representations and understandings of the parties. No supplement, modification or ame ndment of this Agreement shall be binding unless executed in writing by all parties. 16. Waiver: No waiver of any provision of this Agreement shall be deemed, or shall constitute, a waiver of any other provision, whether or not similar, nor shall any waiver constitute a continuing waiver. No waiver shall be binding unless executed in writing by the party making the waiver. - 6 - 17. Binding Effect:This Agreement shall be binding upon the parties hereto and upon their respective executors, administrators, legal representatives, successors, and assi gns. 18. Amendment: This agreement may only be amended or revoked by written amendment signed by both parties. 19. Representation: Each party further agrees and affirms as follows: (a) That the party did execute the agreement voluntarily; and (b) That this agreement is not unconscionable when it was executed; and (c) Both parties were provided prior to execution of this agreement a fair and reas onable disclosure of the property or financial obligations of the other party; (d) Both parties had the opportunity to consult with counsel prior to executing this document. 20. Marriage: The parties make no promise, contract or agreement, one to another, that this cohabitation will result in marriage. 21. Children: Any rights and obligations of the parties relating to children of the parties, if any, shall be governed by separate agreement and the laws of the State of Nebraska. IN WITNESS WHEREFORE, the parties hereby execute this agreement in s everal counterparts, any executed copy of which shall be considered for all purposes as an ori ginal, on the day and year above written. ___________________________________ FIRST PARTY ____________________________________ SECOND PARTY - 7 - STATE OF _____________________ COUNTY OF ________________________ The foregoing instrument was acknowledged before me this __________________ (date) by ______________________________ (name of person acknowledged). ____________________________________ Notary Public _____________________________ Print Name My Commission Expires: _____________________ STATE OF _____________________ COUNTY OF ________________________ The foregoing instrument was acknowledged before me this __________________ (date) by ______________________________ (name of person acknowledged). ____________________________________ Notary Public _____________________________ Print Name My Commission Expires: _____________________ Financial Statement page - 8 -Initials: ________ Exhibit “A” PERSONAL FINANCIAL DISCLOSURE STATEMENT ****************************************************** To: Date: Individual Information Name: Address: City: State:    Zip Occupation: Phone: Current Assets Current Liabilities Cash on Hand or in Banks Notes Payable (Secured)(Schedule F) Other Cash: Notes Payable (Unsecured)(Schedule G) Real Estate (other than residence Schedule A) Real Estate Mortgages Payable (Schedule H) Residence Auto Loans (Schedule I) Motor Vehicles (Schedule B) Unpaid Taxes and Interest US Government Securities (Schedule C) Due to Brokers Non-Marketable Securities (Schedule D) Open Accounts Stocks (Schedule E) Credit Cards (List): Other Personal Property Life Insurance Cash Value Business Interests Notes Receivable Other Assets: Other: Total Liabilities TOTAL OF ALL ASSETS LESS TOTAL OF ALL LIABILITIES Total Assets NET WORTH Individual Income Information (Annual) Salary Bonus Commissions Dividends Rental Income Other Income (List): Total Income Contingent Liabilities Contingent Liabilities Guarantor, Co-maker Guarantor or Co-Maker Lease or Contracts Lease or Contracts Legal Claims Legal Claims Other: Other: Financial Statement page - 2 - Initials: ________ SCHEDULE “A” REAL ESTATE Description of Real Estate Cost Market Value Date Acquired $ $ $ $ $ $ $ $ $ $ $ $ SCHEDULE “B” MOTOR VEHICLES Description of Motor Vehicles Cost Value $ $ $ $ $ $ $ $ $ $ $ $ SCHEDULE “C” U.S. GOVERNMENT SECURITIES Description of Stock or Bond Date Acquired Par Value Market Value $ $ $ $ $ $ $ $ $ $ $ $ SCHEDULE “D” NON MARKETABLE SECURITIES Description Date Acquired Par Value Market Value $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ SCHEDULE “E” STOCKS Company Shares Date Acquired Par Value Market Value $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ SCHEDULE “F” NOTES PAYABLE SECURED Description Date Balance Payment (m/yr) $ $ $ $ $ SCHEDULE “G” NOTES PAYABLE UNSECURED Description Date Balance Payment (m/yr) $ $ $ $ $ $ SCHEDULE “H” REAL ESTATE MORTGAGES Description Date Balance Payment (m/yr) $ $ $ $ $ $ SCHEDULE “I” AUTO LOANS Description Date Balance Payment (m/yr) $ $ $ $ $ $ We/I Certify this Statement to be true and correct as of the date indicated: _________________________________ Signature Financial Statement page - 4 -Initials: ________ Exhibit “B” PERSONAL FINANCIAL DISCLOSURE STATEMENT ****************************************************** To: Date: Individual Information Name: Address: City: State:    Zip Occupation: Phone: Current Assets Current Liabilities Cash on Hand or in Banks Notes Payable (Secured)(Schedule F) Other Cash: Notes Payable (Unsecured)(Schedule G) Real Estate (other than residence Schedule A) Real Estate Mortgages Payable (Schedule H) Residence Auto Loans (Schedule I) Motor Vehicles (Schedule B) Unpaid Taxes and Interest US Government Securities (Schedule C) Due to Brokers Non-Marketable Securities (Schedule D) Open Accounts Stocks (Schedule E) Credit Cards (List): Other Personal Property Life Insurance Cash Value Business Interests Notes Receivable Other Assets: Other: Total Liabilities TOTAL OF ALL ASSETS LESS TOTAL OF ALL LIABILITIES Total Assets NET WORTH Individual Income Information (Annual) Salary Bonus Commissions Dividends Rental Income Other Income (List): Total Income Contingent Liabilities Contingent Liabilities Guarantor, Co-maker Guarantor or Co-Maker Lease or Contracts Lease or Contracts Legal Claims Legal Claims Other: Other: Financial Statement page - 2 - Initials: ________ SCHEDULE “A” REAL ESTATE Description of Real Estate Cost Market Value Date Acquired $ $ $ $ $ $ $ $ $ $ $ $ SCHEDULE “B” MOTOR VEHICLES Description of Motor Vehicles Cost Value $ $ $ $ $ $ $ $ $ $ $ $ SCHEDULE “C” U.S. GOVERNMENT SECURITIES Description of Stock or Bond Date Acquired Par Value Market Value $ $ $ $ $ $ $ $ $ $ $ $ SCHEDULE “D” NON MARKETABLE SECURITIES Description Date Acquired Par Value Market Value $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ SCHEDULE “E” STOCKS Company Shares Date Acquired Par Value Market Value $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Financial Statement page - 3 - Initials: ________ SCHEDULE “F” NOTES PAYABLE SECURED Description Date Balance Payment (m/yr) $ $ $ $ $ SCHEDULE “G” NOTES PAYABLE UNSECURED Description Date Balance Payment (m/yr) $ $ $ $ $ $ SCHEDULE “H” REAL ESTATE MORTGAGES Description Date Balance Payment (m/yr) $ $ $ $ $ $ SCHEDULE “I” AUTO LOANS Description Date Balance Payment (m/yr) $ $ $ $ $ $ We/I Certify this Statement to be true and correct as of the date indicated: _________________________________ Signature