Fill and Sign the Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Children Florida Form

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.902(f)(1) MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) (02/18) When should this form be used? This form should be used when a Petition for Dissolution of Marriage with Dependent or Minor Child(ren) , Florida Supreme Court Approved Family Law Form 12.901(b)(1), has been fled and the parties have reached an agreement on some or all of the issues at hand. This form should be typed or printed in black ink. Both parties must sign the agreement and have their signatures witnessed by a notary public or deputy clerk . After completing this form, you should fle the original with the clerk of the circuit court in the county where the petition was fled and keep a copy for your records. You should then refer to the instructions for your petition, answer , or answer and counterpetition concerning the procedures for setting a hearing or trial ( fnal hearing ). IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be fled electronically except in certain circumstances. Self- represented litigants may fle petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to fle your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you fle. The rules and procedures should be carefully read and followed. Where can I look for more information? Before proceeding, you should read General Information for Self - Represented Litigants found at the beginning of these forms. The words that are in bold underline in these instructions are defned there. For further information, see chapter 61, Florida Statutes, and the instructions for the petition and/or answer that were fled in this case. IMPORTANT INFORMATION REGARDING E-SERVICE Instructions for Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (02/18) ELECTION After the initial service of process of the petition or supplemental petition by the Sherif or certifed process server, the Florida Rules of Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (e-mail) except in certain circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial Administration. . If you elect to participate in electronic service, which means serving or receiving pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of Judicial Administration 2.516. You may fnd this rule at www.flcourts.org through the link to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the A-Z Topical Index. SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the procedures must always be followed once the initial election is made. To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address , Florida Supreme Court Approved Family Law Form 12.915, and you must provide your e-mail address on each form on which your signature appears. Please CAREFULLY read the rules and instructions for: Certifcate of Service (General), Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address , Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516. Special notes... With this form you must also fle a Child Support Guidelines Worksheet , Florida Family Law Rules of Procedure Form 12.902(e), if not already fled. This form does not act to transfer title to the property. Such transfer must be done by deed or supplemental fnal judgment. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fll out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fll out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. Instructions for Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (02/18) IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR COUNTY, FLORIDA Case No.: Division: In re: The Marriage of: , Petitioner, and , Respondent. MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) We, {Petitioner’s full legal name} _______________________________________________ , and {Respondent’s full legal name} ,_________________________________ being sworn, certify that the following statements are true: 1. We were married to each other on {date} . 2. Because of irreconcilable diferences in our marriage (no chance of staying together), we have made this agreement to settle once and for all what we owe to each other and what we can expect to receive from each other. Each of us states that nothing has been held back, that we have honestly included everything we could think of in listing our assets (everything we own and that is owed to us) and our debts (everything we owe), and that we believe the other has been open and honest in writing this agreement. 3. We have both fled a Family Law Financial Afdavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). Because we have voluntarily made full and fair disclosure to each other of all our assets and debts, we waive any further disclosure under rule 12.285, Florida Family Law Rules of Procedure. 4. Each of us agrees to execute and exchange any papers that might be needed to complete this agreement, including deeds, title certifcates, etc. SECTION I. MARITAL ASSETS AND LIABILITIES A. Division of Assets. We divide our assets (everything we own and that is owed to us) as follows: Any personal item(s) not listed below is (are) the property of the party currently in possession of the item(s). Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren)(02/18) 1. Petitioner shall receive as his/her own and Respondent shall have no further rights or responsibilities regarding these assets: ASSETS: DESCRIPTION OF ITEM(S) PETITIONER SHALL RECEIVE Please 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 in one spouse’s name, or in both spouses’ names. 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) (Other) Business interests Automobiles Boats Other vehicles Retirement plans (Proft Sharing, Pension, IRA, 401(k)s, etc.) Furniture & furnishings in home Furniture & furnishings elsewhere Collectibles Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren)(02/18) ASSETS: DESCRIPTION OF ITEM(S) PETITIONER SHALL RECEIVE Please 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 in one spouse’s name, or in both spouses’ names. Current Fair Market Value Jewelry Life insurance (cash surrender value) Sporting and entertainment (T.V., stereo, etc.) equipment Other assets Total Assets to Petitioner $ 2. Respondent shall receive as his/her own and Petitioner shall have no further rights or responsibilities regarding these assets: ASSETS: DESCRIPTION OF ITEM(S) RESPONDENT SHALL RECEIVE Please 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 in one spouse’s name , or in both spouses’ names. 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) Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren)(02/18) ASSETS: DESCRIPTION OF ITEM(S) RESPONDENT SHALL RECEIVE Please 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 in one spouse’s name , or in both spouses’ names. Current Fair Market Value Real estate: (Home) (Other) Business interests Automobiles Boats Other vehicles Retirement plans (Proft 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 Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren)(02/18) ASSETS: DESCRIPTION OF ITEM(S) RESPONDENT SHALL RECEIVE Please 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 in one spouse’s name , or in both spouses’ names. Current Fair Market Value Total Assets to Respondent $ Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren)(02/18) B. Division of Liabilities/Debts. We divide our liabilities (everything we owe) as follows: 1. Petitioner shall pay as his/her own the following and will not at any time ask Respondent to pay these debts/bills: LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY PETITIONER Please 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 in one spouse’s name or in both spouses’ names. Monthly Payment Current Amount Owed Mortgages on real estate: (Home) $ $ (Other) Charge/credit card accounts Auto loan Auto loan Bank/credit union loans Money you owe (not evidenced by a note) Judgments Other Total Debts to Be Paid by Petitioner $ $ Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren)(02/18) 2. Respondent shall pay as his/her own the following and will not at any time ask Petitioner to pay these debts/bills: LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY RESPONDENT Please 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 in one spouse’s name , or in both spouses’ names. Monthly Payment Current Amount Owed Mortgages on real estate: (Home) $ $ (Other) Charge/credit card accounts Auto loan Auto loan Bank/credit union loans Money you owe (not evidenced by a note) Judgments Other Total Debts to Be Paid by Respondent $ $ C. Contingent Assets and Liabilities (listed in Section III of our Family Law Financial Afdavits) will be divided as follows: Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (02/18) . D. Benefciary Designation (Complete only if benefciary designations continue after entry of Final Judgment of Dissolution of Marriage.) _____The spouses agree that the designation providing for the payment or transfer at death of an interest in the assets set forth below to or for the beneft of the deceased party’s former spouse SHALL NOT BE VOID as of the date of entry of the Final Judgment of Dissolution of Marriage. The Final Judgment of Dissolution of Marriage shall provide that the designations set forth below remain in full force and efect: _____1. The _____Petitioner _____Respondent shall acquire or maintain the following assets for the beneft of the other spouse or child(ren) to be paid upon his/her death outright or in trust. This provision only applies if other assets fulflling such requirement for the beneft of the other spouse or child(ren) do not exist upon his/her death and unless precluded by statute. {Describe the assets with specificity}:______________________________________________________________________ ________________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________. _____2. The _____Petitioner _____Respondent shall not unilaterally terminate or modify the ownership of the following assets, or their disposition upon his/her death. {Describe the assets with specificity}:______________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________. SECTION II. SPOUSAL SUPPORT (ALIMONY) (If you have not agreed on this matter, write n/a on the lines provided.) 1. ____Each of us forever gives up any right to spousal support (alimony) that we may have. OR Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (02/18) 2. _____ Petitioner _____ Respondent (hereinafter “Obligor”) agrees to pay spousal support (alimony) in the amount of $ ______every _____ week _____ other week _____month, or ____ other _____________, beginning {date} _________________ and continuing until {date or event} ___________________________________________________. Explain type of alimony (such as, permanent, bridge-the-gap, durational, rehabilitative, and/or lump sum) and any other specifcs:__________________________________________________ 3. _____ Other provisions relating to alimony, including any tax treatment and consequences: ___________________________________________________________________________ ______________________________________________________________________________ . 4. Life insurance in the amount of $____________ to secure the above support, will be provided by the Obligor. SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING 1. The parties’ minor child(ren) are: Name Birth date 2. The parties shall have time-sharing and parental responsibility in accordance with the Parenting Plan attached as Exhibit _____. SECTION IV. CHILD SUPPORT 1. _____ Petitioner ____ Respondent (hereinafter “Obligor”) will pay child support, under Florida’s child support guidelines, section 61.30, Florida Statutes, to the other parent. The Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is completed and attached. Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (02/18) Child support established at the rate of $_________ per month for the ______children { total number of parties’ minor or dependent children} shall be paid commencing_________________ {month, day, year} and terminating ___________________ {month, day, year}. Child support shall be paid in the amount of $ __________ per ___________ {week, month, other} which is consistent with the Obligor’s current payroll cycle. Upon the termination of the obligation of child support for one of the parties’ children, child support in the amount of $____________ for the remaining ____ children {total number of remaining children} shall be paid commencing____________________ {month, day, year} and terminating ________________________________________ {month, day, year}. This child support shall be paid in the amount of $ ________ per ___________ {week, month, other} consistent with Obligor’s current payroll cycle. {Insert schedule for the child support obligation, including the amount, and commencement and termination dates, for the remaining minor or dependent children, which shall be payable as the obligation for each child ceases. Please indicate whether the schedule _____appears below or _____is attached as part of this form} _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ The Obligor shall pay child support until all the minor or dependent child(ren): reach the age of 18; become emancipated, marry, join the armed services, die, or become self-supporting; or until further order of the court or agreement of the parties. The child support obligation shall continue beyond the age of 18 and until high school graduation for any child who is: dependent in fact; between the ages of 18 and 19; and is still in high school, performing in good faith with a reasonable expectation of graduation before the age of 19. If the child support amount above deviates from the guidelines by 5% or more, explain the reason(s) here: ______________________________________________________________________________ 2. Retroactive Child Support or Arrearages. There is currently retroactive child support in the amount of $_________________. There is an arrearage of previously ordered unpaid child support in the amount of $______________. Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (02/18) The total of $ ___ in retroactive and unpaid child support shall be paid at the rate of $ ____________ every _______ week _______ other week ________month, beginning {date} ________________ , until paid in full including statutory interest. 3. Health Insurance. _____ Petitioner _____ Respondent will maintain health insurance for the parties’ minor child(ren). The party providing coverage will provide insurance cards to the other party showing coverage. OR _____ Health insurance is either not reasonable in cost or accessible to the child(ren) at this time. Any uninsured/ unreimbursed medical costs for the minor child(ren) shall be assessed as follows: a. _____Shared equally by the spouses. {Each spouse pays one-half}. b. _____Prorated according to the child support 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. 4. Dental Insurance. _____ Petitioner ____ Respondent will maintain dental insurance for the parties’ minor child(ren). The party providing coverage will provide insurance cards to the other party showing coverage. OR _____ Dental insurance is either not reasonable in cost or accessible to the child(ren) at this time. Any uninsured/ unreimbursed dental costs for the minor child(ren) shall be assessed as follows: a. _____Shared equally by the spouses .{each spouse pays one-half} 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 that expense, according to the schedule of reimbursement set out in this paragraph. 5. Life Insurance. _____ Petitioner _____ Respondent will maintain life insurance for the beneft of the parties’ minor child(ren) in the amount of $ ____________ until the youngest child turns 18, becomes emancipated, marries, joins the armed services, or dies. Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (02/18) 6. IRS Income Tax Exemption(s). The assignment of any tax exemptions for the child(ren) shall be as follows: {explain} __________________________________________________________ _________________________________________________________________________ The other parent will convey any applicable IRS form regarding the income tax exemption. 7. Other provisions relating to child support (e.g., uninsured medical/dental expenses, health or dental insurance, life insurance to secure child support, orthodontic payments, college fund, etc.): SECTION V. OTHER . SECTION VI. We have not agreed on the following issues: . I certify that I have been open and honest in entering into this settlement agreement. I am satisfed with this agreement and intend to be bound by it. Dated: Signature of Petitioner Printed Name: Address: City, State, Zip: Telephone Number: Fax Number: Designated E-mail Address(es): __________________ __________________________________________ Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (02/18) STATE OF FLORIDA COUNTY OF ________________________ Sworn to or afrmed and signed before me on by . NOTARY PUBLIC or DEPUTY CLERK [Print, type, or stamp commissioned name of notary or clerk.] _ Personally known _ Produced identifcation Type of identifcation produced IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fll in all blanks] This form was prepared for the Petitioner This form was completed with the assistance of: {name of individual} ____________________________________________________________, {name of business} _____________________________________________________________, {address} __________________________________ ___________________, {city} _______________, {state} ___ , {zip code}__________, {telephone number} ___. I certify that I have been open and honest in entering into this settlement agreement. I am satisfed with this agreement and intend to be bound by it. Dated: Signature of Respondent Printed Name: Address: City, State, Zip: Telephone Number: Fax Number: Designated E-mail Address(es): __________________ STATE OF FLORIDA Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (02/18) COUNTY OF ___________________________ Sworn to or afrmed and signed before me on by . NOTARY PUBLIC or DEPUTY CLERK [Print, type, or stamp commissioned name of notary or clerk.] _ Personally known _ Produced identifcation Type of identifcation produced ____________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fll in all blanks] This form was prepared for the Respondent This form was completed with the assistance of: {name of individual} _______________________________________________________, {name of business} ________________________________________________________, {address} _____________________________________________________, {city} , {state} __ , {zip code}_________, {telephone number} ________________. Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)