Fill and Sign the Utah Separation Form

                  , Utah       Telephone: (       )       -       Facsimile: (       )       -       ______________________________________________________________________________ IN THE       JUDICIAL DISTRICT COURT       COUNTY, STATE OF UTAH ______________________________________________________________________________       , SEPARATION AND PROPERTY SETTLEMENT AGREEMENT Petitioner, vs. Case No.             ,       Respondent. ______________________________________________________________________________ COMES NOW, Petitioner,                         , and Respondent,                         , and hereby stipulate and agree as follows in settlement of all issues arising out of or connected with the above-entitled action for divorce. 1. Respondent hereby waives the right to file an Answer in this matter, or withdraws any Answer filed, agrees that a default may be entered and agrees that the Court may award Petitioner an uncontested Decree of Divorce and Judgment in this matter consistent with the terms of this Separation and Property Settlement Agreement and without further notice to. 2. The parties hereto agree that the provisions of this Separation and Property Settlement Agreement shall be incorporated into any judgment or Decree of Divorce, and that this Separation and Property Settlement Agreement shall survive, and shall not be merged into any judgment, decree or order which may be issued. - 1 - 3. Petitioner and/or Respondent are actual and bona fide residents of       County, State of Utah, and were for more than three (3) months immediately prior to the commencement of this action. 4. Petitioner and Respondent were duly married at       , Utah on             ,       . 5. The marriage between Petitioner and Respondent is irretrievably broken and there are irreconcilable differences between Petitioner and Respondent, making it impossible for the marriage to continue. 6. Petitioner and Respondent have       minor and adult children who are issue of the marriage. The names and birth dates of the children are as follows:       , born             ,       .       , born             ,       .       , born             ,       .       , born             ,       .       , born             ,       . 7. The parties' minor children have resided in       County for at least six (6) months, and Utah is the home state of the children. 8. Neither party has participated, as a party, witness, or in any other capacity, in any other litigation concerning the custody of the parties' minor children in Utah or any other state. 9. Neither party has any knowledge of any custody proceeding concerning the parties' minor children pending in a court of Utah or any other state. 10. Neither party knows of a person not a party to this proceeding who has physical custody of the parties' minor children or who claims to have custody or visitation rights - 2 - with respect to the parties' minor children. 11. During the course of the parties' marriage, Petitioner Respondent was the primary caretaker of the parties' minor children and was responsible for the day-to-day care of the children. 12. It is in the best interest of the parties' minor children that sole care, custody, control, and guardianship of the parties' minor children be awarded to Petitioner Respondent 13. Petitioner has gross monthly income of $       , or such income will be imputed to Petitioner because Petitioner is voluntarily unemployed or underemployed; Petitioner: is/ is not under court order to pay child support for children other than the children from this marriage, in the sum of $       per month; does/ does not pay alimony to an ex-spouse, in the sum of $       per month; does/ does not contribute anything toward monthly premiums for health, hospital, or dental care insurance on the parties' minor children, in the sum of $       per month; and pays $       in monthly work or education-related child care costs for the parties' minor children. 14. Respondent has gross monthly income of $       , or such income will be imputed to Respondent because Respondent is voluntarily unemployed or underemployed; Respondent: is/ is not under court order to pay child support for children other than the children from this marriage, in the sum of $       per month; - 3 - does/ does not pay alimony to an ex-spouse, in the sum of $       per month; does/ does not contribute anything toward monthly premiums for health, hospital, or dental care insurance on the parties' minor children, in the sum of $       per month; and pays $       in monthly work or education-related child care costs for the parties' minor children. 15. Respondent / Petitioner agrees to pay Petitioner / Respondent child support in accordance with the Utah Uniform Civil Liability for Support Act based on the parties' incomes and the Sole Custody Worksheet, in the sum of $       per month until such time as each of the parties' minor children reaches eighteen (18) years of age or graduates from high school during the child's normal and expected year of graduation, whichever occurs later. Pursuant to Section 78-45-7.10(1) and (2), Utah Code Annotated, upon the occurrence of the foregoing event(s) which terminate child support for one or more of the children, the base child support award will be automatically reduced to reflect the lower base combined child support obligation shown in the child support table for the remaining number of children due child support. The award will not be reduced by a per child amount derived from the base child support award originally ordered. 16. Respondent / Petitioner agrees to make the monthly child support payments in [select one]: two equal monthly installments of one-half of the total monthly obligation, with payments due on the       and       days of each month. one monthly payment due on the       day of each month. - 4 - 17. Respondent / Petitioner agrees to pay all work-related childcare costs for the parties' minor children However, no obligation to pay work-related childcare costs will accrue unless the custodial parent is working and actually incurring childcare costs. Also, the obligation to pay will be contingent upon the non-custodial parent's receipt of proof of the childcare expenses (or reasonable efforts by the custodial parent to provide the non-custodial parent with such proof). Such proof must include written verification of the cost and identity of all childcare providers upon the initial engagement of the provider, and thereafter upon the request of the non-custodial parent. The custodial parent must notify the other parent of any change of childcare provider and of any change in the monthly childcare expenses within thirty (30) days of the date of the change. For purposes of this paragraph, work-related childcare costs means reasonable childcare costs for up to a full- time work week or training schedule as necessitated by the employment or training of the custodial parent. A parent incurring work-related childcare costs will be denied the right to receive credit for the expenses or to recover the other parent's share of the expenses if the parent incurring the expenses fails to provide verifiable proof of incurring such expenses within thirty (30) days of incurring such expenses. Recovery will also be denied if the parent incurring the expenses fails to provide timely notice of any change of childcare provider. 18. Pursuant to Utah Code Annotated, Section 78-45-7.11, the base child support award will be reduced by fifty percent (50%) for each of the parties' minor children for time periods during which the child is with the noncustodial parent by order of the court or by agreement of the parties for at least 25 of any 30 consecutive days. Normal visitation and holiday visits to the custodial parent will not be considered an interruption of the consecutive day requirement. For purposes of this paragraph, the per child amount to which the abatement - 5 - applies will be calculated by dividing the base child support award by the number of children included in the award. 19. Each party agrees to attend and complete the two-hour course entitled Divorce Education for Parents, as required by law within thirty (30) days of his or her execution of this Separation and Property Settlement Agreement. Information and course schedules may be obtained through the Clerk of the District Court. 20. Neither of the parties has received public assistance (AFDC) for the parties' minor children from the State of Utah. 21. Only during any period when Petitioner/ Respondent is receiving ongoing public assistance (AFDC) from the State of Utah, or the State of Utah is collecting child support for Petitioner/ Respondent, the following provisions will apply: a. Petitioner/ Respondent will pay child support, less credits and offsets to which Petitioner/ Respondent is entitled hereunder, other than Court- ordered child care costs, on or before the 5th day of each month to the Utah State Office of Recovery Services, (       ,       , Utah       -       ), unless the Office of Recovery Services notifies Petitioner/ Respondent that payments will be sent elsewhere. When public assistance is being provided for the parties' minor children by the State of Utah, the ongoing child support will be awarded to the State of Utah to the extent necessary to reimburse the State for AFDC payments made to Petitioner/ Respondent. b. Pursuant to Utah Code Annotated, Section 62A-11-404.5 and Section 78-45-9, if the Office of Recovery Services enforces the child support order, - 6 - Petitioner’s/ Respondent’s income will be subject to immediate and automatic withholding as of the effective date of the order, regardless of whether a delinquency exists. c. Each party will keep the Office of Recovery Services informed of changes in his or her address, employment, income, or medical insurance coverage. d. Pursuant to Utah Code Annotated, Section 62A-11-320.5, either party to this action may request that the Office of Recovery Services review the Court's child support order for this action to determine whether a modification of the Court-ordered child support will be pursued. 22. The noncustodial parent will be awarded such reasonable visitation with the parties' minor children as the parties may agree. In the event the parties do not agree on visitation, then the noncustodial parent will be entitled to visitation with the parties' minor children in accordance with the appropriate provisions of Sections 30-3-35 and 30-3-35.5, Utah Code Annotated, as follows: a. One weekday evening to be specified by the noncustodial parent, from 5:30 p.m. until 8:30 p.m.; b. Alternating weekends beginning on the first weekend after the entry of the decree from 6 p.m. on Friday until 7 p.m. on Sunday continuing each year; c. Holidays take precedence over the weekend visitation, and changes shall not be made to the regular rotation of the alternating weekend visitation schedule; d. If a holiday falls on a regularly scheduled school day, the noncustodial parent shall be responsible for the child's attendance at school for that school day; - 7 - e. If a holiday falls on a weekend or on a Friday or Monday and the total holiday period extends beyond that time so that the child is free from school and the parent is free from work, the noncustodial parent shall be entitled to this lengthier holiday period; f. In years ending in an odd number, the noncustodial parent is entitled to the following holidays: (i) The birthday of each of the parties' minor children on the day before or after the actual birth-date beginning at 3 p.m. until 9 p.m.; at the discretion of the noncustodial parent, he or she may take other siblings along for the birthday; (ii) Human Rights Day beginning at 6 p.m. the day before the holiday until 7 p.m. on the holiday; (iii) Easter holiday beginning at 6 p.m. on Friday until Sunday at 7 p.m., unless the holiday extends for a lengthier period of time to which the noncustodial parent is completely entitled; (iv) Memorial Day beginning at 6 p.m. on Friday until Monday at 7 p.m., unless the holiday extends for a lengthier period of time to which the noncustodial parent is completely entitled; (v) July 24th beginning 6 p.m. on the day before the holiday until 11 p.m. on the holiday; (vi) Veteran's Day holiday beginning at 6 p.m. the day before the holiday until 7 p.m. on the holiday; and (vii) The first portion of the Christmas school vacation as defined in - 8 - Subsection 30-3-32(3)(b), plus Christmas Eve and Christmas Day until 1 p.m., so long as the entire holiday is equally divided; g. In years ending in an even number, the noncustodial parent is entitled to the following holidays: (i) The birthday of each of the parties' minor children on the actual birth-date beginning at 3 p.m. until 9 p.m.; at the discretion of the noncustodial parent, he or she may take other siblings along for the birthday; (ii) New Year's Day beginning at 6 p.m. the day before the holiday until 7 p.m. on the holiday; (iii) President's Day beginning at 6 p.m. the day before the holiday until 7 p.m. on the holiday; (iv) July 4th beginning at 6 p.m. the day before the holiday until 11 p.m. on the holiday; (v) Labor Day beginning at 6 p.m. on Friday until Monday at 7 p.m. unless the holiday extends for a lengthier period of time to which the noncustodial parent is completely entitled; (vi) The fall break, if applicable, commonly known as U.E.A. weekend beginning at 6 p.m. on Wednesday until Sunday at 7 p.m. unless the holiday extends for a lengthier period of time to which the noncustodial parent is completely entitled; (vii) Columbus Day beginning at 6 p.m. the day before the holiday until 7 p.m. on the holiday; - 9 - (viii) Thanksgiving holiday beginning Wednesday at 7 p.m. until Sunday at 7 p.m.; and (ix) The second portion of the Christmas school vacation as defined in Subsection 30-3-32(3)(b) plus Christmas day beginning at 1 p.m. until 9 p.m., so long as the entire Christmas holiday is equally divided; h. Father's Day shall be spent with the natural or adoptive father every year beginning at 9 a.m. until 7 p.m. on the holiday; i. Mother's Day shall be spent with the natural or adoptive mother every year beginning at 9 a.m. until 7 p.m. on the holiday; j. Extended visitation with the noncustodial parent shall be: (i) up to four weeks consecutive at the option of the noncustodial parent; (ii) two weeks shall be uninterrupted time for the noncustodial parent; and (iii) the remaining two weeks shall be subject to visitation for the custodial parent consistent with these guidelines; k. The custodial parent shall have an identical two week period of uninterrupted time during the children's summer vacation from school for purposes of vacation; l. If the child is enrolled in year-round school, the noncustodial parent's extended visitation shall be 1/2 of the vacation time for year-round school breaks, provided the custodial parent has holiday and phone visits; - 10 - m. Notification of extended visitation or vacation weeks with the child shall be provided at least 30 days in advance to the other parent; and n. Telephone contact shall be at reasonable hours. 23. Petitioner will pay       % and Respondent will pay       % of all reasonable and necessary uninsured medical and dental expenses incurred for the parties' minor children and actually paid by either parent, including deductibles and co-payments. 24. A parent who incurs medical or dental expenses for the parties' minor children will provide written verification of the cost and payment of medical and dental expenses to the other parent within thirty (30) days of incurring such expense. 25. The parent who obtains medical or dental insurance for the parties' minor children will provide verification of coverage to the other parent, or to the Office of Recovery Services under Title IV of the Social Security Act, 42 U.S.C. Section 602 et. seq., upon initial enrollment of the minor children, and thereafter on or before January 2 of each calendar year. The parent obtaining the insurance will also notify the other parent or the Office of Recovery Services of any change in insurance carrier, premium, or benefits within thirty (30) days of the date he or she first knew or should have known of the change. 26. Petitioner/ Respondent will be responsible for the purchase and maintenance of appropriate medical and dental insurance for the parties' minor children if coverage is or becomes available at a reasonable cost. Petitioner will pay       % and Respondent will pay       % of all such costs. In the event insurance is or becomes available to both parties at a reasonable cost and no advantage to the children's coverage would result from both parents maintaining insurance, then the parent who can obtain the most favorable coverage will maintain insurance with costs split as above. - 11 - 27. Petitioner will pay       % and Respondent will pay       % of the out- of-pocket costs of the medical and dental insurance premium actually paid by a parent for the children's portion of the medical and dental insurance. The children's portion of the premium is a per capita share of the premium actually paid. The premium expense for the children will be calculated by dividing the premium amount by the number of persons covered under the policy and multiplying the result by the number of minor children in this case who are covered by such policy. 28. Until all the parties' minor children reach age eighteen (18) or graduate from high school during the children's normal and expected year of graduation, Petitioner/ Respondent will be required to purchase and continuously maintain life insurance on his life with a death benefit of not less than $       , and will be required to name the parties' minor children as the beneficiaries of said life insurance policy. 29. Petitioner will be entitled to claim the following children as dependents on tax returns: ________________________ ________________________ ________________________ ________________________ ________________________ 30. Respondent will be entitled to claim the following children as dependents on tax returns: ________________________ ________________________ ________________________ ________________________ - 12 - ________________________ 31. The foregoing notwithstanding, a parent will not be allowed to claim the parties' minor children on his or her tax returns unless claiming the children will result in a tax benefit to that parent. If claiming the children will not result in a tax benefit to one of the parents, then the other parent will be entitled to claim the parties' minor children on his or her tax returns. 32. Petitioner/ Respondent will not be entitled to claim the parties' minor children as dependents for tax purposes unless Respondent is current on court ordered child support payments for the children. 33. Petitioner/ Respondent will be required to pay Petitioner/ Respondent temporary/ permanent alimony in the sum of $       per month for a period of       months/ until the death of either party, however pursuant to Utah Code Annotated, Section 30- 3-5(8) and (9), the alimony award in this matter will be automatically terminated upon the remarriage of the party receiving alimony or upon the establishment by the party paying alimony that the former spouse is cohabitating with another person. 34. The parties have acquired certain items of personal property which will be awarded to Petitioner, to wit: 1.       . 2.       . 3. Petitioner's personal effects and clothing. 4. All personal property acquired by Petitioner prior to the parties' marriage. 5. All personal property acquired by Petitioner since the date the parties separated, on or about             ,       . - 13 - 37. The parties have acquired certain items of personal property which will be awarded to Respondent, to wit: 1.       . 2.       . 3. Petitioner's personal effects and clothing. 4. All personal property acquired by Petitioner prior to the parties' marriage. 5. All personal property acquired by Petitioner since the date the parties separated, on or about             ,       . 38. The parties have incurred certain debts, which will be paid by the designated party: DESCRIPTION OF DEBT PARTY RESPONSIBLE ______________________________ ____________________ ______________________________ ____________________ ______________________________ ____________________ ______________________________ ____________________ ______________________________ ____________________ ______________________________ ____________________ ______________________________ ____________________ ______________________________ ____________________ 39. Petitioner and Respondent will each harmless and indemnify the other on all debts and obligations the other agrees to pay. 40. The parties have the following bank accounts and other like assets, full ownership - 14 - of which are assigned to the designated party, as follows: DESCRIPTION OF ACCOUNT OWNER PARTY ______________________________ ____________________ ______________________________ ____________________ ______________________________ ____________________ ______________________________ ____________________ ______________________________ ____________________ ______________________________ ____________________ ______________________________ ____________________ 41. During their marriage the parties acquired an interest in       , which interest will be awarded to       . 42. During their marriage the parties acquired certain real property located at       ,       ,       , and more specifically described as follows:                                                                               Said real estate will be sold immediately at a price agreed upon by the parties. Upon sale of the property, after payment of all outstanding liens and encumbrances on the property, and after payment of all reasonable costs of sale, Petitioner will be awarded       % of the remaining proceeds, and Respondent will by awarded       % of the remaining proceeds. In the event the parties are not able to agree upon a price at which to sell the real estate, the property will be sold at a price set by an appraisal conducted by an independent appraiser selected by mutual agreement of the parties. Any liens or encumbrances which one of the parties causes to be placed on the property after the date of the parties' separation will be paid solely by the party who caused the lien to be placed on the property. Until such time as the property is sold, Petitioner/ Respondent will be entitled to exclusive possession of the property. The party entitled to possession will be responsible for payment of the monthly debt obligations on the - 15 - property until sold. Other agreements relating to said property are as follows: ____________________________ ____________________________ ______________________ ______ ____________________________ ____________________________                   . 43. Petitioner's maiden name of                   will be restored to her. 44. Pursuant to Utah Code Annotated, Section 15-4-6.5(3)(b), both parties will be authorized to provide notice to each creditor of the parties following the entry of the Decree of Divorce for the allocation of debts between the parties. 45. Both parties will be permanently restrained from annoying, bothering, or harassing each other at any time and at any place. 46. Respondent/ Petitioner agrees to pay $                   toward Respondent’s/ Petitioner’s attorney's fees in this case. 47. In the event either party fails to perform his or her obligations under this agreement and/or the Decree of Divorce, such person will be required to pay all costs and attorney fees of the other party incurred in enforcing the terms of this agreement and/or the Decree of Divorce. 48. Each party will be ordered to execute and deliver to the other party without cost any documents necessary to implement the provisions of this agreement and/or the Decree of Divorce entered by the Court. 49. Each party will have the right to dispose of his or her property by last will and testament in such manner as he or she deems proper. The disposition of property by last will and testament will have the same force and effect as if the other party had died. Each party, individually and for his or her heirs, executors, administrators, successors and assigns, hereby waives, releases and relinquishes any and all claims, rights or interests as a surviving spouse in - 16 - or to any property, real or personal, which the other party owns or possesses at death, or to which the other party or his or her estate may be entitled. 50. The intent of the foregoing paragraph is to (a) operate as a waiver of each party's right to any claim on the estate of the other spouse, whether by forced share or otherwise, in the event one of the parties dies prior to the divorce becoming final, (b) nullify and revoke any disposition or appointment of property made in a party's will which purports to name the other party as a beneficiary under such will, and (c) revoke any disposition of property to one of the parties by the other party made by virtue of the existence of any payable on death accounts, by creating a presumption that this Separation and Property Settlement Agreement revokes each spouse's interest in any pay-on-death accounts of the other spouse. 51. In connection with the execution of this Separation and Property Settlement Agreement, the parties have each either had the advice of independent legal counsel, or have specifically waived such counsel. 52. Petitioner and Respondent each acknowledge that all of the matters embodied in this Separation and Property Settlement Agreement, including all terms, covenants, conditions, waivers, releases, and other provisions contained herein, are fully understood by him or her; that he or she is entering into this Separation and Property Settlement Agreement freely, voluntarily and after due consideration of the consequences of doing so; and that this Separation and Property Settlement Agreement is valid and binding upon him or her. - 17 - 53. This Separation and Property Settlement Agreement is entire and complete and contains all understandings and agreements between the parties. No prior or contemporaneous oral or written agreements not made a part of this Separation and Property Settlement Agreement shall be of any force or effect. 54. This Separation and Property Settlement Agreement may not be amended, modified, discharged or terminated except by a writing executed and acknowledged by the party to be bound. In addition, any such writing shall not be valid unless it states in a clear, unambiguous, and conspicuous manner that it is intended to amend, modify, discharge, terminate, or otherwise affect this Separation and Property Settlement Agreement. 55. Any waiver by either party of any provision of this Separation and Property Settlement Agreement shall not be deemed a continuing waiver and shall not prevent such party from thereafter insisting upon strict performance and enforcement of such provision. 56. This Separation and Property Settlement Agreement and all rights and obligation of the parties hereunder shall be construed according to the laws of the State of Utah . If any term, paragraph, or provision of this Separation and Property Settlement Agreement is held invalid or unenforceable for any reason, the remainder of this Separation and Property Settlement Agreement shall continue in full force and effect. 57. This Separation and Property Settlement Agreement is binding upon the parties hereto, and their respective heirs, executors, administrators, successors, and assigns. IN WITNESS WHEREOF, the parties hereto have executed this Separation and Property Settlement Agreement on the dates hereafter indicated. DATED this       day of       , 20       . DATED this       day of       , 20       . - 18 - _________________________________ _________________________________                                                 Petitioner Respondent - 19 - ACKNOWLEDGMENT OF PETITIONER STATE OF UTAH COUNTY OF             On this       day of       , 20       , personally appeared before me                         , the Petitioner, who being first duly sworn, proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to on the foregoing instrument, the SEPARATION AND PROPERTY SETTLEMENT AGREEMENT signed by the Petitioner on the       day of       , 20       , and acknowledged that he/she voluntarily executed the same. Signed: ______________________________ Petitioner _________________________________ NOTARY PUBLIC Residing At: __________________________ My Commission Expires: ________________ ACKNOWLEDGMENT OF RESPONDENT STATE OF UTAH COUNTY OF             On this       day of       , 20       , personally appeared before me                         , the Respondent, who being first duly sworn, proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to on the foregoing instrument, the SEPARATION AND PROPERTY SETTLEMENT AGREEMENT signed by the Respondent on the       day of       , 20       , and acknowledged that he/she voluntarily executed the same. Signed: ______________________________ Respondent ________________________________ NOTARY PUBLIC Residing At: __________________________ My Commission Expires: ________________ - 20 -