Fill and Sign the Separation Mutual Agreement Form

Separation and Support Agreement with Joint Custody, Visitation, and Mutual Support of Children Agreement made on the _________________ (date) , between ____________________ (Name of Husband) of _________________________________________________________ ________________ (street address, city, county, state, zip code) , referred to herein as Husband , and __________________ (Name of Wife) , of ______________________________ _____________________________________ (street address, city, county, state, zip code) , referred to herein as Wife . 1. Statement of Marriage Husband and Wife were married on __________________ (date of marriage) , in _________________ (name of city) , _______________ (name of county) , _______________ (name of state) , and as a result of their marriage, they have two children, namely ____________________ (name of first child) and ______________ (name of second child) . 2. Agreement to Separate As a result of disputes and differences between Husband and Wife , they have (been separated and living apart since [________________ (date of separation) and/or agreed to dissolve their marriage)] . 3. Custody and Support of Children Husband and Wife intend that this Agreement will provide for the custody, visitation and support of their children. 4. Joint Legal Custody of Children Husband and Wife agree that they are both fit and proper parents to have custody of their minor children, ________________ (name of first child) and _________________ (name of second child) , and that it is in the best interests of their children that the parents shall have joint legal custody. The term joint legal custody means shared responsibility for all major decisions concerning the upbringing, education, medical care, dental care, spiritual care and all matters concerning the general welfare of the children. For this purpose, both parents shall consult each other and confer together on matters affecting the welfare of their children, taking into account the best interests of the children and, as far as possible and practicable, the desires of the children. Each parent shall have full authority to sign for emergency medical care, school absence and other activities requiring the signature of either parent. 5. Care of Children Neither Husband nor Wife shall do anything that may estrange their children from the other parent. Each parent shall foster love, respect and understanding between the children and the other parent. 6. Health of Children Each parent shall be entitled to complete information from any doctor, dentist or other health care provider attending to the children and from any school or school authority instructing the children. The names, addresses and telephone numbers of both parents will be on all applicable school and medical records, with a notation that both parents must be called in case of an emergency affecting the children. Both parents shall endeavor to inform the other of school conferences, activities and other matters affecting the children. 7. Residence of Children The children will reside with __________________ (Husband or Wife) during the school week, every other weekend during the school year, and ______ (number of weeks) weeks each during the months of July and August. The children will reside with _____________ (Wife or Husband) every other weekend during the school year, and ________ (number of weeks) weeks each during the months of July and August. The weeks during which the children will reside with either party during the summer will be mutually agreed on between the Husband and Wife at the beginning of each summer. For purposes of this agreement, weekends will begin on Friday at __________ (time of day) , and end on Sunday at __________ (time of day) . ________________ (Husband or Wife) will also have visitation privileges with one or both of the children during the school week, in order to take them out to special functions or activities, including dinner, movies and sports events, provided the children are returned to _________________ (Wife or Husband) at a reasonable time on a school night. 8. Custody of Children on Holidays Husband will have the children during the following holidays: (list of holidays when Husband will have custody) ___________________________________________________. Wife will have the children during the following holidays: (list of holidays when Wife will have custody) _____________________________________________________. This schedule will begin in ____________ (identification of first year) , and will alternate every year, such that the party who has the children for a particular holiday during the year will not have them on such holiday in the following year. 9. Birthdays The children will be with the parent on the day of such parent's birthday, if desired by the parent celebrating the birthday. The children will be with __________________ (Husband or Wife) on each child's birthday in ____________ (identification of first year) , and with _______________ (Husband or Wife) on each one's birthday in ___________ (identification of second year) , alternating each succeeding year, such that the parent who does not have the children on their birthdays one year shall have them during their birthdays the succeeding year. 10. Modification of Custody on Holidays and Birthdays Arrangements for holidays and birthdays are subject to modification on mutual agreement between the Husband and Wife . Each parent shall give the other at least ______ (number of hours) hours' notice if he or she cannot follow the schedule of holidays and birthdays; otherwise such parent will be responsible for obtaining and paying for the child-care services for the period in question. 11. Transportation of Children _______________ (Husband or Wife) will be responsible for picking up the children from _______________ (Wife or Husband) 's residence at the beginning of the period that _____ (he or she) is entitled to their physical custody, and ________________ (Wife or Husband) shall be responsible for picking up the children from __________________ (Husband or Wife) 's residence at the end of the period. 12. Support of Children Husband and Wife will share the expenses of the children in proportion to their respective base salaries or earnings. Both parents will provide each other with pay stubs or other evidences of income status, and agree that they will notify each other whenever their income status has changed. 13. Medical Expenses of Children ___________________ (Husband or Wife) shall provide expenses for the medical and dental care of the children, and for this purpose shall carry ______________________ (type of insurance) or enroll the children in a health maintenance organization licensed to provide health insurance coverage in ________________ (name of state) . 14. Major Expenses of Children Husband and Wife shall communicate with each other in advance to discuss major expenses to be incurred for the children. 15. Transportation Over Long Distances Should the Husband and Wife reside more than __________ (number of miles) miles apart, they will pay for the children's transportation between those residences according to their income ratio. 16. Income Tax Deductions The party who provided the majority of the expenses for the children during the taxable year shall be entitled to claim the children as dependents for that year on federal and ___________________ (name of state) income tax returns, for purposes of the dependency exemption as well as the child tax credit. 17. Re-Evaluation of Agreement This Agreement shall be re-evaluated from time to time, and if deemed necessary by either parent, shall be re-negotiated on the happening of any of the following circumstances: A. Either parent changing residence to another state; B. Remarriage or living together of either parent with a third person; C. Debilitating physical or chronic or dangerous mental disability of either parent; D. A substantial change of income or significant negative change in the occupation of either parent; or E. Any change of circumstances that would affect in a significant manner the welfare of the children. 18. Mediation of Disagreements Any disagreement between the parties respecting any decision affecting the children, or about the interpretation of this agreement, or modification of this agreement, will be resolved by mediation before taking legal action. Expenses for such mediation or legal action shall be shared equally by the parties. 19. Severability The invalidity of any portion of this Agreement will not and shall not be deemed to affect the validity of any other provision. If any provision of this Agreement is held to be invalid, the parties agree that the remaining provisions shall be deemed to be in full force and effect as if they had been executed by both parties subsequent to the expungement of the invalid provision. 20. No Waiver The failure of either party to this Agreement to insist upon the performance of any of the terms and conditions of this Agreement, or the waiver of any breach of any of the terms and conditions of this Agreement, shall not be construed as subsequently waiving any such terms and conditions, but the same shall continue and remain in full force and effect as if no such forbearance or waiver had occurred. 21. Governing Law This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of _______________. 22. Notices Any notice provided for or concerning this Agreement shall be in writing and shall be deemed sufficiently given when sent by certified or registered mail if sent to the respective address of each party as set forth at the beginning of this Agreement. 23 . Entire Agreement This Agreement shall constitute the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. 24. Modification of Agreement Any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if placed in writing and signed by each party or an authorized representative of each party. WITNESS our signatures as of the day and date first above stated. ________________________ _________________________ (P rinted name) (P rinted name) ________________________ _________________________ (Signature of Husband) (Signature of Wife)