Personal Relationship Statement

PERSONAL RELATIONSHIP STATEMENT

Parties

Party A - Full Legal Name:

Party B - Full Legal Name:

Recitals (WHEREAS)

WHEREAS, Party A and Party B desire to record the material facts and mutual commitments that describe their personal relationship for purposes of establishing facts of cohabitation, financial arrangements, and mutual responsibilities;

WHEREAS, the parties intend that this Personal Relationship Statement serve as a contemporaneous written statement of the relationship's essential facts and agreed arrangements as of the Effective Date set forth below;

WHEREAS, the parties acknowledge that this Statement is a record of their current understanding and is to be relied upon by the parties and by third parties to the extent permitted by applicable law.

Scope of Statement

Describe the nature and purpose of this Statement, including whether it documents cohabitation, domestic partnership considerations, financial contributions, parenting arrangements, or other material aspects of the relationship. The parties confirm that the foregoing description is accurate to the best of their knowledge.

Relationship History and Material Facts

Date relationship commenced:

Shared Residence and Household Contributions

Current shared residence address (if applicable):

Financial Arrangements (Payment Terms)

Agreed shared monthly contribution amount:

Payment schedule and method:

Late payment remedy and fee:

The parties acknowledge that these financial arrangements are intended to memorialize contributions in support of the shared household and are without prejudice to legal rights regarding property division, child support, or other statutory entitlements.

Term and Termination

Effective date of this Statement:

This Statement will remain in effect until:

Required notice to terminate or materially amend this Statement:

Upon termination, the parties agree to account for contributions and return or distribute shared property consistent with applicable law and any separate written agreement between the parties.

Confidentiality

The parties agree that the contents of this Statement are confidential and will not be disclosed to third parties except (i) as required by law or court order, (ii) to legal or financial advisors bound by professional confidentiality, or (iii) by mutual written consent of both parties. Any permitted disclosure shall be limited to the minimum necessary information.

Governing Law

This Statement shall be governed by and construed in accordance with the laws of the state of , without regard to conflict of laws principles.

Entire Agreement; Severability

This Statement constitutes the entire written understanding between the parties concerning the matters herein and supersedes all prior oral or written agreements on the same subject. If any provision of this Statement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect and the invalid provision shall be reformed to the extent necessary to effectuate the parties' intent.

Attestation and Certification

Each party certifies under penalty of perjury that the information contained in this Statement is true and correct to the best of their knowledge, that they execute this Statement voluntarily, and that they understand its contents and legal effect.

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