INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF
PROCEDURE FORM 12.902(f)(3)
MARITAL SETTLEMENT AGREEMENT FOR
SIMPLIFIED DISSOLUTION OF MARRIAGE (10/17)
When should this form be used?
This form should be used when a Petition for Simplifed Dissolution of
Marriage , Florida Family Law Rules of Procedure Form 12.901(a), has been fled
and the parties have reached an agreement on 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 ).
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 which was fled in this case.
Special notes...
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 Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement
Agreement for Simplifed issolution of Marriage (10/17)
IN THE CIRCUIT COURT OF THE JU ICIAL CIRCUIT,
IN AN FOR COUNTY, FLORI A
Case No.:
ivision:
In re: the Marriage of:
_________________ ,
Petitioner,
and
_________________ ,
Respondent.
MARITAL SETTLEMENT AGREEMENT FOR
SIMPLIFIED DISSOLUTION OF MARRIAGE
We, {Husband’s full legal name} _______________________________ ,and {Wife’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. Each of us agrees to execute and exchange any documents 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 the property of the
party currently in possession of the item(s).
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for
Simplifed issolution of Marriage (10/17)
1. Wife shall receive as her own and Husband shall have no further rights or
responsibilities regarding these assets:
ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE
To avoid confusion at a later date, describe each item as
clearly as possible.
LIST ONLY THE LAST FOUR DIGITS OF ACCOUNT NUMBERS.
Where applicable, include whether the name on any
title/deed/account described below is wife’s, husband’s, or
both. 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
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for
Simplifed issolution of Marriage (10/17)
ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE
To avoid confusion at a later date, describe each item as
clearly as possible.
LIST ONLY THE LAST FOUR DIGITS OF ACCOUNT NUMBERS.
Where applicable, include whether the name on any
title/deed/account described below is wife’s, husband’s, or
both. Current
Fair
Market
Value
Collectibles
Jewelry
Life insurance (cash surrender value)
Sporting and entertainment (T.V., stereo, etc.) equipment
Other assets
Total Assets to Wife $
2. Husband shall receive as his own and Wife shall have no further rights or
responsibilities regarding these assets:
ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE
To avoid confusion at a later date, describe each item as
clearly as possible.
LIST ONLY THE LAST FOUR DIGITS OF ACCOUNT NUMBERS.
Where applicable, include whether the name on any
title/deed/account described below is wife’s, husband’s or
both. Current
Fair
Market
Value
Cash (on hand) $
Cash (in banks/credit unions)
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for
Simplifed issolution of Marriage (10/17)
ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE
To avoid confusion at a later date, describe each item as
clearly as possible.
LIST ONLY THE LAST FOUR DIGITS OF ACCOUNT NUMBERS.
Where applicable, include whether the name on any
title/deed/account described below is wife’s, husband’s or
both. Current
Fair
Market
Value
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
Jewelry
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for
Simplifed issolution of Marriage (10/17)
ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE
To avoid confusion at a later date, describe each item as
clearly as possible.
LIST ONLY THE LAST FOUR DIGITS OF ACCOUNT NUMBERS.
Where applicable, include whether the name on any
title/deed/account described below is wife’s, husband’s or
both. Current
Fair
Market
Value
Life insurance (cash surrender value)
Sporting and entertainment (T.V., stereo, etc.) equipment
Other assets
Total Assets to Husband $
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for
Simplifed issolution of Marriage (10/17)
B. Division of Liabilities/Debts. We divide our liabilities (everything we owe)
as follows:
1. Wife shall pay as her own the following and will not at any time ask Husband to pay
these debts/bills:
LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY
WIFE
To avoid confusion at a later date, describe each item
as clearly as possible.
LIST ONLY THE LAST FOUR DIGITS OF ACCOUNT
NUMBERS.
Where applicable, include whether the name on any
mortgage, note, or account described below is wife’s,
husband’s, or both. 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 Wife $ $
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for
Simplifed issolution of Marriage (10/17)
2. Husband shall pay as his own the following and will not at any time ask Wife to pay
these debts/bills:
LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY
HUSBAND
To avoid confusion at a later date, describe each item
as clearly as possible.
LIST ONLY THE LAST FOUR DIGITS OF ACCOUNT
NUMBERS.
Where applicable, include whether the name on any
mortgage, note, or account described below is wife’s,
husband’s, or both. 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 Husband $ $
C. Contingent Assets and Liabilities (listed in Section III of our Family Law
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for
Simplifed issolution of Marriage (10/17)
Financial Afdavits) will be divided as follows:
.
SECTION II. SPOUSAL SUPPORT (ALIMONY) Each of us forever gives up any
right to spousal support (alimony) that we may have.
SECTION III. OTHER
______________________________________________________________________________
______________________________________________________________________________
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.
ated: ______ ___________
Signature of Husband
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
E-mail
Address(es):______________________________
STATE OF FLORI A
COUNTY OF
Sworn to or afrmed and signed before me on by .
NOTARY PUBLIC or EPUTY CLERK
{Print, type, or stamp commissioned name
of notary or clerk.}
_____ Personally known
_____ Produced identifcation
Type of identifcation produced
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for
Simplifed issolution of Marriage (10/17)
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 Husband who is the {choose only one }
____Petitioner _____Respondent.
This form was completed with the assistance of:
{name of individual}
________________________________________________________________,
{name of business}
__________________________________________________________________,
{address} ________________ _________________________________,
{city} ____________________________ , {state} ______ , {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.
ated:
Signature of Wife
Printed
Name:__________________________________
Address:_____________________________________
_
City, State,
Zip:_________________________________
Telephone
number:_____________________________
Fax
Number ____________________________________________
E-mail
Address(es):_____________________________
STATE OF FLORI A
COUNTY OF
Sworn to or afrmed and signed before me on by .
NOTARY PUBLIC or EPUTY CLERK
{Print, type, or stamp commissioned name
of notary or clerk.}
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for
Simplifed issolution of Marriage (10/17)
_____ 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 Wife who is the {choose only one } ____Petitioner
_____ Respondent.
This form was completed with the assistance of:
{name of individual} _____________________________________________________________,
{name of business} _______________________________________________________________,
{address} ___________ __________________________________________________ ,
{city} ___________ ____ , {state} _ , {telephone number}
___________________.
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for
Simplifed issolution of Marriage (10/17)
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