NC-DO-1A
INSTRUCTIONS
When should this form be used?
This form should be used when the parties desire to enter into a Separation Agreement but no
divorce action has been filed to be effective immediately. This form is for married persons
with no children without joint property or debts. This form is for the State of North
Carolina.
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 si gned original of the
document.
Transfers of Title to Property
This form may not be sufficient to transfer title to property such as real estate, aut omobiles 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 Agreement as a contract between
the parties regardless of whether a divorce action is filed. Certain conduct may inval idate the
Agreement such as cohabitation and sexual relations with each other after signing the
Agreement. If a divorce action is filed, the Court may or may not be bound by all provisions
contained in the Agreement. For example, Courts generally have the final say about chi ld
custody, child support, alimony and other like matters.
Husband Initials:___________ Wife Initials: ___________
MARITAL SEPARATION AND PROPERTY SETTLEMENT AGREEMENTWITH NO DEPENDENT OR 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 AGREEMENT.
STATE OF NORTH CAROLINA
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, irreconcilable differences have arisen in the marriage of the parties whic h
has resulted in the parties living separate and apart without cohabitation and t here is no chance of
staying together. The parties make this Agreement to settle once and for all what 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 settlement of t heir rights,
liabilities, obligations and property rights arising out of and during the course of their marit al
relationship. No reconciliation is contemplated; and
WHEREAS, the parties agree to execute and exchange any papers that might be needed
to complete this Agreement, including deeds, title certificates, bills of sale, etc.; and
Husband Initials:___________ Wife Initials: ___________
WHEREAS, the parties intend that this Agreement shall be binding on them from and
after the date and time of execution, if permitted, and that this Agreement may be incorporated
into a final judgment of divorce at some future time.
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 stateme nts contained
herein are true and correct:
SECTION 1.
SEPARATION; RELINQUISHMENT OF MARITAL RIGHTS
The parties shall continue to live separate and apart, free from interference, authority and
control by the other, as if each were sole and unmarried, and each may conduct, ca rry on and
engage in any employment, business or trade which each shall seem advisable for their sol e and
separate use and benefit, without, and free from any control, restraint or interference by t he other
party in all respects as if each were unmarried. Neither of the parties shall m olest or annoy the
other or seek to compel the other to cohabit or dwell with the other by any proceedi ngs for
restoration of conjugal rights or otherwise, or exert or demand any right to reside in the home of
the other, if any.
SECTION 2.
FINANCIAL DISCLOSURES
By execution of this instrument, each party warrants and represents to the other party
that he or she has fully disclosed their financial status, including their assets a nd liabilities of
all types and agree that the terms of this Agreement are fair, just, and equita ble after
consideration of the financial status of the parties.
SECTION 3.
Husband Initials:___________ Wife Initials: ___________
ASSETS
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 e xcept
as otherwise provided herein. There is no joint property to divide. All property titled in t he
name of Husband shall be and remain his and all property titled in the name of W ife shall be and
remain hers. Retirement Accounts. The parties represent that all retirement and pension types of
accounts have been disclosed and agree that there will not be a division of retireme nt pension
accounts and each party shall keep their respective retirement and pension type accounts. Life Insurance. The parties agree that they will remove each other’s names from their
respective life insurance policies. Further, that from and after the date of this Agre ement,
husband and wife disclaim, waive and renounce the right to receive any life insurance be nefits or
proceeds, if any, to which they would have been entitled as beneficiary on a life poli cy
maintained by the other even if they have not been removed as the designated bene ficiary on the
date of death of the insured.
Household Furnishing and Effects. (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 below.
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, or
as provided below.
Husband agrees that the Wife shall retain all of the household furnishings and effects
presently located on the premises at _________________________________________,
excepting those items already removed by the Husband, or to be removed, with the Wife's
permission, or as provided below.
Husband shall be entitled to possession of the following household furnishing and effects:
____________________________________________________________________________
Husband Initials:___________ Wife Initials: ___________
____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Wife shall be entitled to possession of the following household furnishings and effects:
____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________
Each party shall retain as his or her own all of their personal clothing, jewelry and effects.
Marital Home.
Husband owns improved premises, which has been occupied as the marital residence
of the parties located at ___________________________________________________. It is
understood and agreed that the Husband shall remain and live in the house and be fully
responsible for its mortgage payments and utility charges and other expenses, if any, in
connection with the same. Wife shall retain no interest in said home, legal or equitable.
Wife owns improved premises, which has been occupied as the marital residence of
the parties located at _______________________________________________________. It is
understood and agreed that the Wife shall remain and live in the house and be ful ly responsible
for its mortgage payments and utility charges and other expenses, if any, in connection with the
same. Husband shall retain no interest in said home, legal or equitable.
Husband and Wife rent premises, which has been occupied as the marital residence of
the parties located at _____________________________________. It is understood and agreed
that the Wife shall remain and live in the rental premises and be fully re sponsible for all rental
payments and utility charges and other expenses in connection with the same. Husband shal l
retain no interest in said premises, legal or equitable.
Husband and Wife rent premises, which has been occupied as the marital residence of
the parties located at _____________________________________. It is understood and agreed
that the Husband shall remain and live in the rental premises and be fully responsibl e for all
Husband Initials:___________ Wife Initials: ___________
rental payments and utility charges and other expenses in connection with the same. Wife shall
retain no interest in said premises, legal or equitable.
Other: _____________________________________________________________
____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________
SECTION 3.
NO CHILDREN
There have been no children born to the marriage of Husband and Wife. Wife is not now
pregnant. No Children have been adopted by the parties.
SECTION 4.
MUTUAL WAIVER OF ALIMONY OR OTHER SUPPORT
In consideration of the provisions contained herein for the respective benefits of the
parties and other good and valuable considerations, the parties hereto mutually waive any and all
claim or right to temporary or permanent alimony, maintenance or support, whether past, pre sent
or future.
SECTION 5.
DEBTS, LIABILITIES AND EXPENSES
Each party agrees to pay their respective debts and agree that there are no joint debts that
remain unpaid at the time of the execution of this Agreement. Husband shall pay his debt s and
Wife shall pay her debts. Each party agrees to be fully responsible for their own individual medical expenses and
will maintain their own medical plans, which they may carry either individua lly or through their
place of employment.
SECTION 6
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
Husband Initials:___________ Wife Initials: ___________
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.
SECTION 7.
MUTUAL INDEMNITY
The parties agree in regard to the payment of debts and other liabilities as sta ted in this
Agreement that each shall indemnify and hold harmless the other for the payment of same.
SECTION 8.
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 ta x liability,
penalty or deficiency associated with his or her income and shall hold the othe r party harmless
therefor. 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 pertaining to this Agreement and have been directed and advised to obta in
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 9.
ADDITIONAL OR FURTHER DOCUMENTS; COOPERATION
Each party agrees 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 pa rty 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 includi ng
any deeds, affidavits, tax forms or other instruments required of one party to the other in order t o
pass good or merchantable title to any property owned by either party during the marital
relationship.
Husband Initials:___________ Wife Initials: ___________
SECTION 10.DIVORCE
It is agreed and understood that this Agreement finally settles all rights of the parties and
the property jointly or individually owned by the parties, and that this Agreement, and the
enforceability thereof, is not contingent upon either party or both parties being granted a divorce
on any grounds. However, if either or both parties are granted a divorce on any grounds, the
parties agree that this Agreement shall be made a part thereof and that such de cree or judgment
shall not conflict with the terms hereof except to the extent disapproved by the Court . In the
event that the law governing this Agreement prohibits this Agreement from being effe ctive until
a divorce action has been filed, or a Judgment of Divorce entered, then the parties a gree that such
event shall be the effective date of this Agreement. In the event a divorce act ion or judgment is
required prior to this Agreement becoming effective, or in the event that a divorce a ction is
desired by one or more of the parties, both parties agree and sign and execute all ple ading and
papers required to obtain a divorce and jointly request and consent to the immediate submission
of this Agreement to the applicable Court and to an entry of a judgment by incorporati on of this
Agreement into the final decree or judgment of divorce.
SECTION 11.
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 act ion may be
taken by either party as is necessary to enforce or modify the terms and provisions hereof, e xcept
that the Property Settlement provision shall not be subject to modification.
SECTION 12.
ABSENCE OF DURESS OR UNDUE INFLUENCE
The parties agree and state that each has freely and voluntarily entered int o this
Agreement. This Agreement was executed free of any duress, coercion, collusion, or undue
Husband Initials:___________ Wife Initials: ___________
influence. In some instances, the Agreement represents a compromise of disputed issues;
however, both parties believe that its terms and conditions are fair and reasonable.SECTION 13.
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 and t o 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 hereafter. 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 c laimed
to exist at or prior to the date of this Agreement; and, both parties specifically wa ive 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 from 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 recipi ent 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 14.
ENFORCEMENT
This Agreement may be enforced by actions and proceedings for Contempt of Court, or
Husband Initials:___________ Wife Initials: ___________
attachment and garnishment, for specific performance, or any other remedy legally available to
either Defendant or Plaintiff, for the enforcement of the provisions and covenants of this
Agreement.SECTION 15.
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 pe tition
a court of competent jurisdiction for spousal support in an amount sufficient to cover any
amounts so discharged.
SECTION 16.
ENTIRE AGREEMENT
This Agreement constitutes the entire Agreement between the parties and each pa rty
acknowledges that there are no further Agreements not expressly included herein and that thi s
Agreement may be modified, altered, or amended only in writing, duly signed and notarized by
each in the form of this original. SECTION 17.
FULLY READ AND UNDERSTAND; INFORMED CONSENT
Each party represents and acknowledges that he or she has fully read this Agreement, consulte d
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 collusi on
by either party or any third party, and that each party signed same with the full knowle dge of
said party's rights, obligations, and responsibilities. Each party agrees that they have had a
reasonable opportunity to consult with an attorney of their choice in the negotiation a nd
preparation of this document, and regarding any divorce proceeding.
SECTION 18.
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, implement ed and
administered as if such void, voidable or unenforceable portion did not appear herein.
Husband Initials:___________ Wife Initials: ___________
SECTION 19.
CONTROLLING LAW
This Agreement shall be governed, enforced and interpreted according to the laws of the
State of North Carolina. SECTION 20.
HEIRS AND ASSIGNS
This Agreement shall be binding upon the heirs, administrators, estate and assigns of the
parties. 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 satisfi ed 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 NORTH CAROLINA
COUNTY OF _____________________
I, a Notary Public, do hereby certify that _________________________________ (here
give the name of the grantor or maker) personally appeared before me this day and
acknowledged the due execution of the foregoing instrument. Witness my hand and (where an
official seal is required by law) official seal
Husband Initials:___________ Wife Initials: ___________
This the ___________________ day of ___________________ (year).
(Official seal.) ______________________________Notary Public
Printed Name: _________________
My Commission Expires: _____________________
STATE OF NORTH CAROLINA
COUNTY OF _____________________ I, a Notary Public, do hereby certify that _________________________________ (here
give the name of the grantor or maker) personally appeared before me this day and
acknowledged the due execution of the foregoing instrument. Witness my hand and (where an
official seal is required by law) official seal
This the ___________________ day of ___________________ (year).
(Official seal.) ______________________________Notary Public
Printed Name: _________________
My Commission Expires: _____________________