FL -DO -11
INSTRUCTIONS
When should this form be used?
This form should be used when the parties desire to enter into a Separation Agreement in
contemplation of a divorce, which has been filed or will be filed prior to effective date of this
Agre ement. This form is for married persons with children. Parties may have joint
property or debts. This form is for the State of Florida.
This form should be completed on your computer, typed or printed in black ink. Both parties
must sign the Agreement and have their signatures witnessed by a notary public . You may
desire to print and sign duplicate originals so that both parties will have a signed original of the
document.
Transfers of Title to Property
This form may not be sufficient to transfer title to property such as real estate, automobiles and
other property to be divided. These transfers must be done by a deed, bill of sale, title or other
instruction before the ownership is final.
Opportunity to Consult with Attorney
This Agreement provides that you were given an opportunity to consult with an attorney of your
choice prior to execution of the Agreement.
Divorce Proceeding
This form provides that the parties intend to be bound by this Agreem ent subject to approval by
the appropriate Court. The parties will file a divorce proceeding prior to signing this Agreement,
or have pending a divorce action at the time of execution.
Husband Initials:___________ Wife Initials: ___________
IN THE CIRCUIT COURT OF THE ___________________ JUDICIALCIRCUIT,
IN AND FOR ______________________ COUNTY, FLORIDA
In Re the Marriage of: )
)
____________________________ )
)
) NO. _______________________
v. )
)
____________________________ )
)
MARITAL SEPARATION AND PROPERTY SETTLEMENT AGREEMENT
WITH DEPENDENT MINOR CHILD(REN)
NOTICE: THIS IS AN IMPORTANT LEGAL AGREEMENT AND HAS
SUBSTANTIAL LEGAL CONSEQUENCES ON YOU, YOUR RIGHTS AND
OBLIGATIONS. YOU ARE ADVISED TO CONSULT AN ATTORNEY FOR
INDEPENDENT LEGAL ADVICE PRIOR TO EXECUTION OF THIS AGREEM ENT.
STATE OF FLORIDA
COUNTY OF _________________
WHEREAS, ____________________________________ (full legal name), hereinafter
referred to as "Wife", and _________________________________ (full legal name),
hereinafter referred to as "Husband", are now married, having been married on the _____
day of ____________, _______, in ______________ County, _________________; and
WHEREAS, the parties were separated on or about the _______ day of
_______________, 20___, while residing in _______________ County,
_________________, and since that date have been living separate and apart; and
WHEREAS, differences have arisen between the parties that have resulted in the
marriage being irretrievably broken and there is no chance of staying together. The
Husband Initials:___________ Wife Initials: ___________
parties make this Agreement to settle once and for all that the parties owe to each other
and what the parties can expect to receive from each other; and
WHEREAS, the parties desire to make a mutually acceptable set tlement of their rights,
liabilities, obligations and property rights arising out of and during the course of their
marital relationship and child custody, support and visitation. No reconciliation is
contemplated; and
WHEREAS, the parties agree to exec ute and exchange any papers that might be needed
to complete this Agreement, including deeds, title certificates, bills of sale, etc.; and
WHEREAS, the parties intend that this Agreement shall be binding and effective subject
to approval by the Court in that certain action pending in the Circuit Court of the
___________ Judicial District In and For _______________ County, Florida, Cause
Number _____________, which is a divorce action involving Husband and Wife.
NOW THEREFORE, FOR AND IN CONSIDERATION of the mutual benefits and
advantages accruing to each party, the undersigned do hereby solemnly covenant, agree
and contract as set forth above and below and being sworn, certify that the all statements
contained herein are true and correct:
SECTION 1.
SEP ARATION; RELINQUISHMENT OF MARITAL RIGHTS
The parties shall continue to live separate and apart, free from int erference,
authority and control by the other, as if each were sole and unmarried, and each may
conduct, carry on and engage in any employment, business or trade which each shall
seem advisable for their sole and separate use and benefit, without, and free from any
control, restraint or interference by the other party in all respects as if each were
unmarried. Neither of the parties shall molest or annoy the other or seek to compel the
other to cohabit or dwell with the other by any proceedings for restora tion of conjugal
rights or otherwise, or exert or demand any right to reside in the home of the other, if any.
Husband Initials:___________ Wife Initials: ___________
SECTION 2.
FINANCIAL DISCLOSURES
By execution of this instrument, each party warrants and represents to the other
party that he or she has full y disclosed their financial status, including their assets and
liabilities of all types and agree that the terms of this Agreement are fair, just, and
equitable after consideration of the financial status of the parties.
SECTION 3.
ASSETS
A. In General . Husband and Wife are in possession of all personal property
belonging to each, and neither makes any claim to any personal property in the
possession of the other except as otherwise stated in this Agreement. The parties
agree to divide their assets (eve rything they own and that is owed to parties) as
provided below. Any personal item(s) not listed below is the property of the
party currently in possession of the item(s). Each party shall retain as his or her
own all of their personal clothing, jewelry and effects.
B. Wife shall receive as her own and Husband shall have no further rights or
responsibilities regarding these assets:
ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE
(To avoid confusion at a later date, describe each item as clearly as po ssible. You do not need to list account
numbers. Where applicable, include whether the name on any title/deed/account described below is wife’s,
husband’s, or both.)
Current Fair Market Value
Cash (on hand) $ Cash (in banks/credit unions) Stocks/Bonds Notes (money owed to you in writing) Money owed to you (not evidenced by a note)
Real estate: (Home)
$
Husband Initials:___________ Wife Initials: ___________
ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE
(To avoid confusion at a later date, describe each item as clearly as po ssible. You do not need to list account
numbers. Where applicable, include whether the name on any title/deed/account described below is wife’s,
husband’s, or both.)
Current Fair Market Value
(Other) $
Business interests
Automobiles
Boats
Other vehicles
Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.)
Furniture & furnishings in home
Furniture & furnishings elsewhere
Collectibles
Jewelry
Life insurance (cash surrender value)
Sporting and entertainment (T.V., stereo, etc.) equipment
Other assets
Total Assets to Wife
$
Husband Initials:___________ Wife Initials: ___________
C. Husband shall receive as his own and Wife shall have no further rights or
responsibilities regarding these assets:
ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE
(To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list account
numbers. Where applicable, include whether the name on any title/deed/account described below is wife’s,
husband’s or both.)
Current Fair
Mar ket Value
Cash (on hand)
$
Cash (in banks/credit unions)
Stocks/Bonds
Notes (money owed to you in writing)
Money owed to you (not evidenced by a note)
Real estate: (Home)
(Other)
Business interests
Automobiles
Boats
Other vehicles
Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.)
Furniture & furnishings in h ome
Furniture & furnishings elsewhere
Collectibles
Jewelry
$
Husband Initials:___________ Wife Initials: ___________
ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE
(To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list account
numbers. Where applicable, include whether the name on any title/deed/account described below is wife’s,
husband’s or both.)
Current Fair
Mar ket Value
Life insurance (cash surrender value) $
Sporting and entertainment (T.V., stereo, etc.) equipment
Other assets
Total Assets to Husband
$
D. Contingent Assets and Liabilities shall be divided as follows:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
E. Additional Retirement Account Provisions . The parties represent that all
retirement and pension types of accounts have been disclosed and agree to the
following division of same:
Retirement Accounts Person to Receive Current Fair
Market Value
Husband Accounts: $ $
Wife Accounts:
$ $
Husband Initials:___________ Wife Initials: ___________
F. Additional Life Insurance Provisions . The parties agree in reference to their
respective life insurance policies the following (indicate policies, owner,
beneficiary): _______________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
_____________________________________________________ _____________
__________________________________________________________________
__________________________________________________________________
G. Additional Household Furnishing and Effects Provisions. (Select as
appropriate)
The household furnishings and effects of the parties have been mutually
divided by the parties and neither makes claim to any such property in the
possession of the other except as provided above.
Wife agrees that the Husband shall retain all of the household furnishings and
effects presently located on the premises at
_______ _________________________________, excepting those items already
removed by the Wife, or to be removed, with the Husband’s permission, except as
listed and provided above.
Husband agrees that the Wife shall retain all of the household furnishings and
effects presently located on the premises at
_________________________________________, excepting those items alread y
removed by the Husband, or to be removed, with the Wife's permission, and
except listed and provided above.
H. Additional Marital Home Provisions .
The marital home of the parties shall be:
i) Occupied by ( ) Husband ( ) Wife.
ii) Titled in the name of ( ) Husband ( ) Wife.
The expenses of the marital home are and shall be paid as follows:
Husband Initials:___________ Wife Initials: ___________
i) ( ) Wife ( ) Husband shall pay the mortgage payments. This
obligation terminates ___________________________________.
ii) ( ) Wife ( ) Husband shall pay the utilities and other expenses
in connection with the upkeep and maintenance of the home. This
obligation terminates ____________________________________.
iii) ( ) Wife ( ) Husband shall pay all taxes, insurance and
assessments . This obligation terminates ___________________
_____________________________________________________.
I. Additional Provisions or explanations: _________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
SECTION 4.
DEBTS, LIABILITIES AND EXPENSES
A. Except as otherwise provided herein each party agrees to pay their respecti ve
individual debts.
B. Division of Liabilities/Debts. The parties divide their liabilities (everything they
owe) as follows:
Wife shall pay as her own the following and will not at any time ask Husband to pay
these debts/bills:
LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY WIFE
(To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any mortgage, note, or account
described below is wife’s, husband’s, or both.)
Monthly
Payment
Current
Amount Owed
Mortgages on real estate: (Home)
$
$
(Other)
Charge/credit card accounts
$
$
Husband Initials:___________ Wife Initials: ___________
LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY WIFE
(To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any mortgage, note, or account
described below is wife’s, husband’s, or both.)
Monthly
Payment
Current
Amount Owed
$ $
Auto loan
Auto loan
Bank/credit unio n loans
Money you owe (not evidenced by a note)
Judgments
Other
Total Debts to Be Paid by Wife
$
$
C. Husband shall pay as his own the following and will not at any time ask Wife to
pay these debts/bills:
LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY HUSBAND
(To avoid confusion at a later date, describe each item as clearly as possible. You do not n eed to list
account numbers. Where applicable, include whether the name on any mortgage, note or account
described below is wife’s, husband’s, or both.)
Monthly
Payment
Current
Amount Owed
Mortgages on real estate: (Home)
$
$
(Other)
Charge/credit card accounts
$
$
Husband Initials:___________ Wife Initials: ___________
LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY HUSBAND
(To avoid confusion at a later date, describe each item as clearly as possible. You do not n eed to list
account numbers. Where applicable, include whether the name on any mortgage, note or account
described below is wife’s, husband’s, or both.)
Monthly
Payment
Current
Amount Owed
Auto loan
$
$
Auto loan
Bank/credit union loans
Money you owe (not evidenced by a note)
Judgments
Other
Total Debts to Be Paid by Husband
$
$
SECTION 5.
FUTURE EARNINGS AND ACQUISITIONS
All income, earnings, or other property received or acquired by either party to this
Agreement on or after the date of execution of this Agreement shall be the sole and
separate property of the receiving or acquiring party. Each party, as of the effective date
of this Agreement, does hereby and forever waive, release, and relinquish all right, title,
and interest in all such income, earnings and other property except as necessary to collect
any sums due hereunder in the event of default.
SECTION 6.
SPOUSA L SUPPORT (ALIMONY)
[ one only]
_________ 1. In consideration of the provisions contained herein for the respective
benefits of the parties and other good and valuable considerations, the parties hereto
Husband Initials:___________ Wife Initials: ___________
mutually waive any and all claim or right to temp orary or permanent alimony,
maintenance or support, whether past, present or future. Thus, each of the parties
forever give up any right to spousal support (alimony) that they may have from the
other.
__________ 2. ( ) Husband ( ) Wife agrees to pay spousal support (alimony) in the
amount of $ ___________ every ( ) week ( ) other week ( ) month, beginning ___
__________________ {date} and continuing until ______________________________
{date or event}.
Explain type of alimony (temporary, permanent, rehabilitative, and/or lump sum) and any
other specifics:
[ if applies]
( ) Life insurance in the amount of $ to secure the above support, will be
provided by the obligor.
SECTION 7.
CHILD CUSTODY, PARENTAL RESPONSIBILITY, AND VISITATION
A. The following child(ren) have been born to the marriage of the parties:
Name Birth date
_________________________ _____________
_________________________ _____________
____________ _____________ _____________
_________________________ _____________
B. Parental Responsibility Child Custody
Both Husband and Wife are proper persons to have the permanent legal
and physical custody, parental respons ibility, care and control of the minor
children of the parties. Husband and Wife shall share the decision -making rights,
the responsibilities and the authority relating to the health, education and welfare
Husband Initials:___________ Wife Initials: ___________
of the children, and shall, therefore, make joint decisions concerning the
children’s health, education and welfare. Both Husband and Wife shall exchange
information concerning the health, education and welfare of the minor children,
and shall confer with one another in the exercise of decision -making r ights,
responsibilities and authority. Husband and Wife shall have equal access to all
medical, dental and school records concerning the minor children.
However, the parties agree that the best interest of the child(ren) at this
time is that primary par ental responsibility and physical custody of the minor
child(ren) will be and agree as follows:
( ) Husband shall have primary parental responsibility and custody of the
minor child(ren) of the parties subject to the visitation rights of Wife.
( ) Wif e shall have primary parental responsibility and custody of the
minor child(ren) of the parties subject to the visitation rights of Husband.
( ) Husband and Wife shall have joint primary parental responsibility and
custody of the minor child(ren) of the parties, both legal and physical.
C. Secondary Parental Responsibility, Visitation, or Time Sharing -
General Provisions .
Visitation shall be conducted pursuant the following general provisions:
i) Visitation should be pleasant for the children and for the parent.
Visitation should help the children maintain a good relationship
with the non -custodial parent.
ii) Visitation means the visiting parent will have the children visit in
his or her home ov ernight. It may include trips and outings
elsewhere.
iii) Visitation schedules shall be followed and the visiting parent shall
inform the other parent when he or she cannot comply with the
schedule.
iv) Adjustment of the visitation schedule from time to time may be
necessary according to the children's ages, health and interests.
Husband Initials:___________ Wife Initials: ___________
v) Visitation should provide meaningful personal contact for both the
visiting parent and the children.
vi) Visitation should not be used to check on the other parent and the
children should not be questioned for information about the other
parent.
vii) Both parents should strive to agree on matters pertaining to the
children, including discipline, so that one parent is not
undermining the other parent's efforts.
viii) It is in the child's best interest for each parent to have a frequent,
meaningful and continuing relationship with their children. For
children to make an adequate adjustment to the dissolution of their
parents marriage, the children must be allowed to c ontinue their
relationship with both parents, experience minimal changes in their
lifestyle if at all possible, and not experience post -divorce conflict
between their parents.
D. Secondary Parental Responsibility, Visitation, or Time Sharing - Schedule.
The non -custodial parent is entitled to reasonable visitation with the minor
child(ren). Husband and Wife adopt the following visitation schedule for the non -
custodial parent:
Birth to 1 Year of Age
i) Non -custodial parent shall have four (4) visits with the child per
week, with such contact lasting four (4) hours in length.
ii) If the child is taken from the home of the custodial parent, the
child shall be returned at least one (1) hour before evening
bedtime.
iii) Holiday Access
Holiday access ta kes precedence over the regularly scheduled
visitation plan.
The non -custodial parent shall be entitled to the following:
On each child's birthday from 5:00 p.m. until 8.00 p.m.;
Memorial Day Monday from 2:00 p.m. until 6:00 p.m.;
Labor Day Monday from 2 :00 p.m. until 6:00 p.m.;
Husband Initials:___________ Wife Initials: ___________
Thanksgiving Day from 2:00 p.m. until 6:00 p.m.;
Christmas Day from 2:00 p.m. until 6:00 p.m.;
Independence Day from 2:00 p.m. until 6:00 p.m.;
Mother's Day with Mother from 2:00 p.m. until 4:00 p.m. and
Father's Day with Father from 2:00 p.m. until 4:00 p.m.
1 Year of Age to 5 Years of Age
i) The non -custodial parent shall have access on alternate weekends
from Friday at 6:00 p.m. until Sunda y at 6:00 p.m.
ii) Additionally, the non -custodial parent shall be permitted one (1)
week night each and every week with the child from 5:30 p.m.
until 7:30 p.m.
iii) Holiday Access
Holiday access takes precedence over the regularly scheduled
access/vis itation plan.
The non -custodial parent shall be entitled to the following:
In years ending in an odd number:
The night before each child's birthday from 5:00 p.m. until 8:00
p.m.;
Memorial Day Monday from 9:00 a.m. until 6:00 p.m.;
Independence Day fro m 9:00 a.m. until 6:00 p.m.;
Thanksgiving Day from 9:00 a.m. until 6:00 p.m.;
Christmas Eve from 6:00 p.m. until Christmas Day at 10:00 a.m.;
In years ending in an even number:
Each chi ld's birthday from 5:30 p.m. until 7:30 p.m.;
Easter from 8:00 a.m. until 6:00 p.m.;
Labor Day Monday from 9:00 a.m. until 6:00 p.m.;
Halloween evening from 5:30 p.m. until 8:00 p.m.;
Christmas Day from 10:00 a.m. until 7:00 p.m.
iv) Summer Visitation
The non -custodial parent shall have one (1) week of vacation with
the children each June, July and August of each year. The non -
custodial parent shall notify the custodial parent in writing no later
Husband Initials:___________ Wife Initials: ___________
than May 1st of each year as to the specific weeks of suc h summer
visitation.
5 Years of Age and Beyond
i) Non -custodial parent shall have access with the child on
alternate weekends from Friday at 6:00 p.m. until Sunday
at 6:00 p.m. and on the Wednesday preceding the weekend
access fr om 5:30 p.m. to 7:30 p.m.
ii) In addition, the non -custodial parent shall have access with
the child during the week immediately following the
weekend visitation on Tuesday and Thursday evening from
5:30 p.m. until 7:30 p.m.
iii) Holiday Access:
Holiday access takes precedence over the regularly
scheduled access/visitation plan.
The non -custodial parent shall be entitled to the following:
In years ending in an odd number:
The night before each child's birthday from 5:00 p.m. to
8:00 p.m.;
Spring Break from Friday at 6:00 p.m. to the Sunday prior
to the start of school at 6:00 p.m.;
Memorial Day weekend from 6:00 p.m. on Friday until
6:00 p.m. on Monday;
Independence Day from 6:00 p.m. on July 3rd until 6:00
p.m. on July 5th;
Thanksgiving h oliday from 6:00 p.m. on Wednesday until
6:00 p.m. on Sunday;
From 6:00 p.m. on December 26th until
6:00 p.m. on January 1st.
In years ending in an even number:
Each child's birthday from 5:30 p.m. until 7:30 p.m.;
Easter weekend from 6:00 p.m. on Good Friday until 6:00
p.m. on Easter Sunday;
Labor Day weekend from 6:00 p.m. on Friday until 6:00
p.m. on Monday;
Husband Initials:___________ Wife Initials: ___________
Halloween evening from 5:30 p.m. until 9:00 p.m.
Christmas holiday from 6:00 p.m. on December 20th until
6:00 p.m. on December 26th.
iv) Mother' s Day/Father's Day
The mother shall have access every Mother's Day weekend
from Friday at 6:00 p.m. until Sunday at 6:00 p.m.; the
father shall have access every Father's Day weekend from
Friday at 6:00 p.m. until Sunday at 6:00 p.m.
v) Summer Visitatio n:
The non -custodial parent shall have five (5) weeks of
summer visitation with the child to be taken in no more
than two (2) week intervals and with such weekly or two
(2) week visits to be nonconsecutive. The non -custodial
parent shall notify the custod ial parent in writing no later
than May 1 st of each year as to the specific weeks of such
summer visitation.
E. Secondary Parental Responsibility, Visitation, or Time Sharing -
Additional Provisions.
In exercising visitation rights the following additional provisions apply:
1. Conflicts Between Regular Weekend, Holiday, and Extended Summer
Visitation. Where there is a conflict between a holiday weekend and the
regular weekend visitation, the holiday takes precedence. Thus, if the
non -custodial parent misses a regular weekend because it is the custodial
parent's holiday, the regular alternating visitation schedule will resume
following the holiday. If the non -custodial parent received two
consecutiv e weekends because of a holiday, the child will spend the
following weekend with the custodial parent. When there is a conflict
between holiday visitation and extended summer visitation, the holiday
visitation takes precedence. When there is a conflict b etween regular
weekend visitation and extended summer visitation, extended summer
visitation takes precedence.
2. Appropriate Conduct By Parents . Parents shall, at all times, avoid
speaking negatively about each other and should firmly discourage such
conduct by relatives or friends. Each parent should encourage the children
to support the other parent. The basic rules of conduct and discipline
established by the custodial parent should be the baseline standard for
Husband Initials:___________ Wife Initials: ___________
both parents, and consistently enforc ed by both, so that the children do not
receive mixed signals.
3. Parental Communication. Parents shall at all times keep each other
advised of their home and work addresses and telephone numbers. So far
as possible, all communication concerning the ch ildren shall be conducted
between the parents in person, or telephonically at their residences (and
not at their places of employment).
4. Grade Reports and Medical Information. The custodial parent shall
provide the non -custodial parent with grade repo rts and notices from
school as they are received and shall, consistent with ___________ law,
permit the non -custodial parent to communicate concerning the children
directly with the school and with the children's doctors and other
professionals, outside th e presence of the custodial parent. Each parent
shall immediately notify the other of any medical emergencies or serious
illnesses of the children. The custodial parent shall notify the non -
custodial parent of all school or other events (like Church or S couts)
involving parental participation. If the children are taking medications,
the custodial parent shall provide a sufficient amount and appropriate
instructions.
5. Visitation Clothing. The custodial parent shall send an appropriate
supply of the c hildren's clothing with them, which shall be returned clean
(when reasonably possible), with the children, by the non -custodial parent.
The non -custodial parent shall advise, as far in advance as possible, of
any special activities so that the appropriate clothing may be sent.
6. Visitation or Support Disputes. Neither visitation nor child support is to
be withheld because of either parent's failure to comply with a court order.
The children have a right to both support and visitation, neither of which
is dependent upon the other. In other words, failure to pay support does
not mean no visitation and no visitation does not mean no support. If
there is a violation of either a visitation or a support order, the exclusive
remedy is to apply to the court f or appropriate sanctions.
7. Adjustments to This Visitation Schedule. Although this is a rather
specific schedule, the parties are expected to fairly modify visitation when
family necessities, illnesses or commitments reasonably so require. The
request ing party shall give as much notice as circumstances permit.
8. Pickup and Drop -off. Unless other arrangements are made, the
non -custodial parent shall pick up the children at the times specified and
return them at the times specified. The custodial pa rent shall have the
children ready for visitation at the time they are to be picked up and shall
Husband Initials:___________ Wife Initials: ___________
be present at the home to receive the children at the time they are
returned. Unjustified violations of this provision may result in the
offender being subjec t to contempt of court. (Commentary: While it is
most desirable for the parents to pick up and return the children, this
provision does not prohibit grandparents, current spouses or other
appropriate adults known to the children.)
9. Extracurricular Act ivities. Children are often involved in sports,
lessons, and other extracurricular activities, which are generally to their
benefit and enjoyment. Each parent shall recognize that a reasonable
amount of extracurricular activities are generally assumed to be in the
children's best interests. Each parent should attempt to be flexible in order
to accommodate the children's extracurricular activity schedules as must
as reasonably possible, although extracurricular activities should not
supersede summer visita tion with non -custodial parents, nor should they
be used as a method by which to deny access to the non -custodial parent.
In recognition of the scheduling difficulties that can be caused by
children's extracurricular activities, custodial parents should a ct in good
faith in attempting to schedule such extracurricular activities as not to
unreasonably infringe upon the non -custodial parent's access to the
children. Likewise, the non -custodial parent should act in good faith in
attempting to assist in trans portation needs and in accommodating the
children's extracurricular schedules as much as reasonably possible. Good
faith communication by the parents is essential with regard to the difficult
issue of the scheduling of children's extracurricular activitie s.
10. Notice of Canceled Visitation. Whenever possible, the non -custodial
parent shall give a minimum of three (3) days notice of intent not to
exercise all or part of the scheduled visitation. When such notice is not
reasonably possible, the maximum notice permitted by the circumstances,
and the reason therefore, shall be given. The custodial parent shall give
the same type of notice when good cause exists making the cancellation or
modification of scheduled visitation necessary.
11. Missed Visitation. In the event the non -custodial parent misses visitation
as the result of illness of the child or parent, an emergency, or other such
reasonable excuse, the parties shall make a good faith effort to make up a
portion of that visitation w ithin a reasonable period of time, understanding
the importance of the non -custodial parent's continuing and frequent
contact with the children. (Commentary: It is important to remember that
illness should not necessarily deprive the non -custodial parent o f visitation
with the children. Clearly, a non -custodial parent can take care of a sick
child as well as the custodial parent in many circumstances.)
Husband Initials:___________ Wife Initials: ___________
12. Custodial Parent's Vacation. Unless otherwise specified, the custodial
parent shall be entitled to a period of vacation with the children no less
than that accorded the non -custodial parent, whose visitation shall abate
during the first fourteen days thereof, and thereafter only so long as
distance makes visitation impracticable.
13. Caretaker Provis ion. As a general rule, each parent shall have the right
of first refusal for childcare or baby sitting needs of the other parent for
durations of four hours or more. Whenever either parent has a need for
child care or baby sitting for a duration of four hours or more, that parent
should always make a good faith attempt first to inquire of the other
parent, with as much advance notice as reasonably possible, whether the
other parent desires to provide child care or baby sitting. The other parent
is under no obligation to provide the childcare or baby -sitting. If the other
parent elects to provide such childcare or baby sitting, it shall be done at
no cost. This provision is intended to provide each parent additional
access to the children whenever reason ably possible.
14. Telephone and Mail Privileges. Each parent shall allow liberal and
reasonable telephone and mail privileges with the children.
15. Medical Reports and Bills. The Custodial parent shall provide copies of
all medical information, and documentation, including bills, within seven
(7) days of their receipt and shall immediately notify the other parent in
the event of a medical emergency. Every effort shall be mad e for the
custodial parent to provide the non -custodial parent with the necessary
information of a medical expense in order to get the bill satisfied. The
parent with the medical insurance shall provide the other parent with a
copy of the explanation of b enefits within seven (7) days from the date of
receipt of same so that the uninsured portion of the bill can be quickly
calculated and paid within a reasonable period of time.
16. Abatement of Support During Extended Visitation. If the non -
custodial par ent's support obligation is current, support shall abate by 50
percent during any visitation of seven (7) consecutive days or more. If
support is not current, the 50 percent that would have been abated shall be
paid and shall apply to the existing arrearag e. (Commentary: If the
custodial parent actually receives the full amount of child support during
this period and if support is current, it is the custodial parent's obligation
to refund the money immediately to the non -custodial parent. This
alleviates many of the problems that arise when wage -withholding orders
have been issued.)
17. Modification. If the parties mutually agree permanently to change the
provisions of their decree of divorce, they must petition the Court to
Husband Initials:___________ Wife Initials: ___________
approve and order that chang e. In the event that the parties do not obtain a
court order, the Court will not be bound by any alleged agreement of the
parties.
F. Other Provisions.
{explain any other agreed -upon arrangements}
______________________________________ ____________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Neither parent shall take the child(ren) from the custody of the other parent or any
child care provider or other person entrusted by the other parent with the care of
the child(ren) without the agreement of the other party during the other party’s
time of parental responsibility or visitation.
SECTION 8.
CHILD SUPPORT, HEALTH INSURANCE, DENTAL INSURANCE
A. Amount and Person to Pay. ( ) Husband ( ) Wife will pay child support to
( ) Wife ( ) Husband for the benefit of the minor children of the parties in the
amount of $___________ , per child, every ( ) week ( ) other week ( )
month, beginning ______________________ {date} and continuing until
modified by court order, or the minor child(ren) becomes an adult, emancipated,
marries , dies, otherwise becomes self -supporting. (Note: Child support is stated
in terms of amount per child.)
B. Child Support Arrearage. There currently is a child support arrearage of
$ _________________ for retroactive child support and/or $ for
previously ordered unpaid child support. The total of $ in child
support arrearage shall be repaid at the rate of $ every ( ) week ( ) other
week ( ) month, beginning _______________________, until paid in full
including statutor y interest.
C. Health Insurance. ( ) Husband ( ) Wife will ( ) maintain health insurance
Husband Initials:___________ Wife Initials: ___________
coverage for the parties’ minor child(ren). The party providing coverage will
provide insurance cards to the other party showing coverage. OR ( ) Health
insurance is not reasonably available at this time. Any uninsured/ unreimbursed
medical costs for the minor child(ren) shall be assessed as follows:
( ) a. Shared equally by both parents.
( ) b. Prorated according to the child sup port guideline percentages.
( ) c. Other {explain} :_____________________________________
__________________________________________________________
As to these uninsured/unreimbursed medical expenses, the party who incurs the
expense shall submit a request for reimbursement to the other party within 30
days, and the other party, within 30 days of receipt, shall submit the applicable
reimbursement for that expense, according to the schedule of reimbursement set
out in this paragraph.
D. Dental Insurance. ( ) Husband ( ) Wife will maintain ( ) dental insurance
coverage for the parties’ minor child(ren). The party providing coverage will
provide insurance cards to the other party showing coverage. OR ( ) dental
insurance is not reasonably available at this time. Any uninsured/ unreimbursed
dental costs for the minor child(ren) shall be assessed as follows:
( ) a. Shared equally by both parents.
( ) b. Prorated according to the child support guideline percentages.
( ) c. Other {explain} :____________________________________
______________________________________________________
As to these uninsured/unreimbursed dental expenses, the party who incurs the
expense shall submit a request for reimbursement to the other party within 30
days, and the other party, within 30 days of receipt, shall submit the applicable
reimbursement for t hat expense, according to the schedule of reimbursement set
out in this paragraph.
E. Life Insurance. ( ) Husband ( ) Wife shall be required to maintain life
insurance coverage for the benefit of the parties’ minor child(ren) in the amo unt
of $ until the youngest child becomes an adult, becomes emancipated,
Husband Initials:___________ Wife Initials: ___________
marries, dies, or otherwise becomes self -supporting.
F. IRS Income Tax Deduction(s). The parent granted primary residential
responsibility or sole parental responsibility of the parties’ minor child(ren) shall
have the benefit of any tax deductions for the child(ren) or as follows {explain} :
__________________________________________________________________
__________________________________________________________________
The other parent will convey any applicable IRS form regarding the income tax
deduction.
G. Other provisions relating to child support (e.g., uninsured medical/dental
expenses, insurance coverage, life insurance to secure child support, orthodontic
payments , college fund, etc.):
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
SECTION 9.
MUTUAL INDEMNITY
The parties agree in regard to the payment of debts and other liabilities as stated
in this Agreement that each shall indemnify and hold harmless the other for the payment
of same.
SECTION 10.
INCOME TAXES
With respect to any earlier year in which the parties filed joint Federal and State
Income Tax Returns, each party agrees to indemnify the other for any income tax
liability, penalty or deficiency associated with his or her income and shall hold the other
party harmless therefor.
Husband Initials:___________ Wife Initials: ___________
The parties shall file separately for the year _______ and each year thereafter.
The parties acknowledge that they have been advised that there may be certain
tax consequences perta ining to this Agreement and have been directed and advised to
obtain independent tax advice from qualified tax accountants or tax counsel prior to
signing this Agreement, and that each party has had an opportunity to do so.
SECTION 11.
ADDITIONAL OR FURTHER DOCUMENTS; COOPERATION
Each party a grees that he or she will sign and execute any further or additional
documents as may be necessary to put into effect the intended purposes hereof. Each
party shall execute, acknowledge and deliver to the other party any and all instruments
and assurances that the other party may reasonably require or find convenient, expedient,
or businesslike for the purpose of giving full force and effect to the provisions of this
Agreement, specifically including any deeds, affidavits, tax forms or other instruments
req uired of one party to the other in order to pass good or merchantable title to any
property owned by either party during the marital relationship.
SECTION 12.
DIVORCE
It is agreed and understood that this Agreement finally settles all rights of the
part ies and the property jointly or individually owned by the parties, and that this
Agreement shall be incorporated into judgment of the _______________ Court of
_____________ County, _____________, Cause Number _______________. The
parties agree that this Agreement shall be made a part of a final decree or judgment and
such decree or judgment shall not conflict with the terms hereof except to the extent
disapproved by the Court. The parties agree that each mutually submits to the personal
jurisdiction of the Circuit Court of the ___________ Judicial District In and For
_______________ County, Florida,
so that said Court has the power to decide any and all matters and questions concerning
the dissolution of the parties’ marriage, and the division of the pa rties’ property and
debts.
Husband Initials:___________ Wife Initials: ___________
SECTION 13.
MODIFICATION
This Agreement shall stop and preclude either party from making other or further
demands and claims upon the other, not included herein, except that such legal action
may be taken by either party as is necessary to enforce or modify the terms and
provisions hereof, except that the Property Settlement provision shall not be subject to
modification.
SECTION 14.
ABSENCE OF DURESS OR UNDUE INFLUENCE
The parties agree and state that each has freely and volu ntarily entered into this
Agreement. This Agreement was executed free of any duress, coercion, collusion, or
undue influence. In some instances, the agreement represents a compromise of
disputed issues; however, both parties believe that its terms and cond itions are fair
and reasonable.
SECTION 15.
RELEASE, WAIVER, BINDING EFFECT, AND ESTATES
Except as otherwise provided for in this Agreement, each party shall be divested
of and each party waives, renounces and gives up all right, title and interest in an d to the
property awarded to the other. All property and money received and retained by the
parties shall be the separate property of the respective party, except as is specifically
stated herein.
Except for those rights and obligations contained in this Agreement, or arising
therefrom by operation of law, both parties do hereby release and forever discharge the
other party from all actions, causes of actions, claims and demands whatsoever, known
and unknown, suspected and unsuspected, apparent now or here after. It is the specific
agreement and purpose of this paragraph to release and discharge any and all claims and
causes of actions of any kind or nature whatsoever whether specifically mentioned or not,
which may exist or might be claimed to exist at or p rior to the date of this Agreement;
Husband Initials:___________ Wife Initials: ___________
and, both parties specifically waive any claim or right to assert that any cause of action or
alleged cause of action or claim or demand has been, through oversight or error or
intentionally or unintentionally, omitted f rom this release and agreement.
The parties shall refrain from, release and relinquish any and all claims that he or
she may have had, may now have, or may hereafter acquire to share in any capacity or to
any extent whatsoever, in the estate of the other, whether by way of statutory allowance,
heirship, homestead rights, or election to take against or under the other party’s Last
Will and Testament. It is the intent of the parties that neither shall be a beneficiary or
recipient of property of the other by Will or intestate succession from and after the date
of this Agreement and expressly waive and reliquinsh any such right regardless of
whether the Will of the other has been changed to delete the gift to her or him and
regardless of whether one party shall die prior to the entry of a final judgment of
divorce.
SECTION 16.
ENFORCEMENT
This Agreement may be enforced by actions and proceedings for Contempt of
Court, or attachment and garnishment, for specific performance, or any other remedy
legally available to either Husband or Wife, for the enforcement of the provisions and
covenants of this Agreement.
SECTION 17.
BANKRUPTCY
To the extent of any obligation contained herein is discharged in bankruptcy and
the non -bankrupt party is held liable for said debt , the non -bankrupt party shall have the
right to petition a court of competent jurisdiction for spousal support in an amount
sufficient to cover any amounts so discharged.
SECTION 18.
ENTIRE AGREEMENT
This Agreement constitutes the entire agreement betwe en the parties and each
party acknowledges that there are no further agreements not expressly included herein
Husband Initials:___________ Wife Initials: ___________
and that this Agreement may be modified, altered, or amended only in writing, duly
signed and notarized by each in the form of this original.
SECT ION 19.
FULLY READ AND UNDERSTAND; INFORMED CONSENT
Each party represents and acknowledges that he or she has fully read this
Agreement, consulted with each other, carefully considered same, and have signed and
executed same after such consultation, that the signing of this Agreement is free and
voluntary without force or collusion by either party or any third party, and that each party
signed same with the full knowledge of said party's rights, obligations, and
responsibilities. Each party agrees that the y have had a reasonable opportunity to consult
with an attorney of their choice in the negotiation and preparation of this document, and
regarding any divorce proceeding.
SECTION 20.
SEVERABILITY
If any portion of the Agreement shall be held to be void, voidable or
unenforceable for any reason, then all the remaining parts or portions shall be construed,
implemented and administered as if such void, voidable or unenforceable portion did
not appear herein.
SECTION 21.
CONTROLLING LAW
This Agreement shall be governed, enforced and interpreted according to the laws
of the State of North Carolina.
SECTION 22.
EFFECTIVE DATE; HEIRS AND ASSIGNS
This Agreement shall be binding upon the parties and their legal representatives,
successor, he irs and assigns, subject to approval by the Court in which divorce
proceedings are instituted or pending.
Husband Initials:___________ Wife Initials: ___________
EXECUTED AND AGREED ON THE DATES SET FORTH BELOW. I certify that I
have been open and honest in entering into this Settlement Agreement. I am sati sfied
with this Agreement and intend to be bound by it.
Dated:
Signature of Wife
Printed Name: _____________________________
Address: __________________________________
City, State, Zip:
Telephone Number:
Fax Number:
Dated:
Signature of Husband
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
STATE OF FLORIDA
COUNTY OF _____________________
The foregoing instrument was acknowledged before me this ________________ (date),
by __________________________________________ (name), who is personally known to me
or who has produced ____________________________ (type of identification) as identificatio n.
______________________________
Notary Public
Printed Name: __________________
My Commission Expires:
____________________
Commission #_________
Husband Initials:___________ Wife Initials: ___________
STATE OF FLORIDA
COUNTY OF _____________________
The foregoing instrument was acknowledged before me this ________________ (date),
by __________________________________________ (name), who is personally known to me
or who has produced ____________________________ (type of identification) as identificatio n.
___________________________________
Notary Public
Printed Name: _______________________
My Commission Expires:
____________________
Commission #_________
