Separation Agreement

Marital Separation and Property Settlement Agreement
With Dependent Minor Child(ren)

Husband Initials:     Wife Initials:

INSTRUCTIONS

When should this form be used?

This form should be used when the parties desire to enter into a Separation Agreement for attachment to and incorporation into a Petition for Dissolution of Marriage. This form is for married persons with children. Parties may have joint property or debts.

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 three originals so that an original may be attached to the Petition for Dissolution of Marriage and 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 Agreement subject to approval by the appropriate Court.

THE COURT OF

COUNTY FOR THE STATE OF

In Re the Marriage of:

v.

NO.

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 AGREEMENT.

STATE OF

COUNTY OF

WHEREAS, , hereinafter referred to as "Wife", and , 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 and there is no chance of staying together. The 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 settlement 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 execute 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 Court of County, , 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.
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, 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 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 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 (everything 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:

Current Fair Market Value:

C. Husband shall receive as his own and Wife shall have no further rights or responsibilities regarding these assets:

Current Fair Market Value:

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:

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 already 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:

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 respective 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:

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:

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.
SPOUSAL 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 mutually waive any and all claim or right to temporary 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 and continuing until .

Explain type of alimony (temporary, permanent, rehabilitative, and/or lump sum) and any other specifics:

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 responsibility, 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 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 rights, 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 parental 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.

Wife 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.

D. Secondary Parental Responsibility, Visitation, or Time Sharing - Schedule.

E. Secondary Parental Responsibility, Visitation, or Time Sharing - Additional Provisions.

F. Other Provisions.

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 and continuing until modified by court order, or the minor child(ren) becomes an adult, emancipated, marries, dies, otherwise becomes self-supporting.

B. Child Support Arrearage.

C. Health Insurance.

Husband Wife will maintain health insurance coverage for the parties’ minor child(ren).

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 support guideline percentages.

c. Other (explain):

D. Dental Insurance.

Husband Wife will maintain dental insurance coverage for the parties’ minor child(ren).

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):

E. Life Insurance.

Husband Wife shall be required to maintain life insurance coverage for the benefit of the parties’ minor child(ren) in the amount of until the youngest child becomes an adult, becomes emancipated, marries, dies, or otherwise becomes self-supporting.

F. IRS Income Tax Deduction(s).

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.

The parties shall file separately for the year and each year thereafter.

SECTION 11.
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 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 required 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 parties 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 Court of County, , 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 parties’ property and debts.

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 voluntarily 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 conditions 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 and 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 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 claimed to exist at or prior to the date of this Agreement; 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 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 recipient of property of the other by Will or intestate succession from and after the date of this Agreement and expressly waive and relinquish 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 between the parties and each party acknowledges that there are no further Agreements not expressly included herein 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.

SECTION 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 they 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 .

SECTION 22.
EFFECTIVE DATE; HEIRS AND ASSIGNS

This Agreement shall be binding upon the parties and their legal representatives, successor, heirs and assigns, subject to approval by the Court in which divorce proceedings are instituted or pending.

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 satisfied with this Agreement and intend to be bound by it.

STATE OF

COUNTY OF

Sworn to or affirmed, acknowledged, executed, signed and delivered before me on by .

_________________________________________
NOTARY PUBLIC

My Commission Expires:

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