WV-DO-3A INSTRUCTIONS When should this form be used? This form should be used when the parties desire to enter into a Separation Agreement to be
effective immediately. This form is for married persons with adult children with joint
property or debts. This form is for the State of West Virginia.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 duplicate originals so that 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 as a contract between
the parties regardless of whether a divorce action is filed. Certain conduct may invalidate the
Agreement such as cohabitation and sexual relations with each other after signing the
Agreement. If a divorce action is filed, the Court may or may not be bound by all provisions
contained in the Agreement. For example, Courts generally have the final say about child
custody, child support, alimony and other like matters.
Husband Initials:___________ Wife Initials: ___________ MARITAL SEPARATION AND PROPERTY SETTLEMENT AGREEMENT WITH ADULT 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 WEST VIRGINIACOUNTY OF _________________ WHEREAS, ____________________________________ (full legal name), hereinafter
referred to as "Wife", and _________________________________ (full legal name),
hereinafter referred to as "Husband", are now married, having been married on the _____
day of ____________, _______, in ______________ County, _________________; andWHEREAS, 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; andWHEREAS, irreconcilable differences have arisen between the parties that have resulted
in the marriage being irretrievably broken 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; andWHEREAS, 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. No reconciliation is contemplated; andWHEREAS, 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
Husband Initials:___________ Wife Initials: ___________WHEREAS, the parties intend that this Agreement shall be binding on them from and
after the date and time of execution, if permitted, and that this Agreement may be
incorporated into a final judgment of divorce at some future time.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.
Husband Initials:___________ Wife Initials: ___________ 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: ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE (To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list 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 (Profit Sharing, Pension, IRA, 401(k)s, etc.) $
Husband Initials:___________ Wife Initials: ___________ ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE
(To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list 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 Furniture & furnishings in home Furniture & furnishings elsewhere Collectibles Jewelry Life insurance (cash surrender value) Sporting and entertainment (T.V., stereo, etc.) equipment Other assets Total Assets to Wife$ C.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. You do not need to list 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 $$
Husband Initials:___________ Wife Initials: ___________ ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE
(To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list account
numbers. Where applicable, include whether the name on any title/deed/account described below is wife’s,
husband’s or both.) Current Fair
Market Value Notes (money owed to you in writing) Money owed to you (not evidenced by a note) Real estate: (Home) (Other) Business interests Automobiles Boats Other vehicles Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) Furniture & furnishings in home Furniture & furnishings elsewhere Collectibles Jewelry Life insurance (cash surrender value)Sporting and entertainment (T.V., stereo, etc.) equipment Other assets $$
Husband Initials:___________ Wife Initials: ___________ ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE
(To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list 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 Total Assets to Husband$ 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:
Retirement Accounts Person to Receive Current Fair
Market Value Husband Accounts:$$Wife Accounts:$$F. Additional Life Insurance Provisions. The parties agree in reference to their
respective life insurance policies the following (indicate policies, owner,
beneficiary): _______________________________________________________
____________________________________________________________________________________________________________________________________ __________________________________________________________________ __________________________________________________________________
Husband Initials:___________ Wife Initials: _______________________________________________________________________________________________________________________________________________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: _________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________
Husband Initials:___________ Wife Initials: ___________ 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: LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY WIFE (To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any mortgage, note, or account
described below is wife’s, husband’s, or both.) Monthly
PaymentCurrent
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 $$ Other
Husband Initials:___________ Wife Initials: ___________ LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY WIFE
(To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any mortgage, note, or account
described below is wife’s, husband’s, or both.) Monthly
PaymentCurrent
Amount Owed Total Debts to Be Paid by Wife$$ C. Husband shall pay as his own the following and will not at any time ask Wife to
pay these debts/bills:LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY HUSBAND (To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any mortgage, note or account
described below is wife’s, husband’s, or both.) MonthlyPaymentCurrent
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 $$ Other
Husband Initials:___________ Wife Initials: ___________ LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY HUSBAND
(To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any mortgage, note or account
described below is wife’s, husband’s, or both.) Monthly
PaymentCurrent
Amount Owed Total Debts to Be Paid by Husband$$ 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__________________ {date} and continuing until ______________________________
{date or event}.Explain type of alimony (temporary, permanent, rehabilitative, and/or lump sum) and any
other specifics:
Husband Initials:___________ Wife Initials: ___________[ / if applies] ( ) Life insurance in the amount of $ to secure the above support, will be
provided by the obligor.
SECTION 7.CHILD (REN) The following child (ren) have been born to the marriage of the parties: Name Birth date All child (ren) are adults, self-supporting and emancipated and there is no need to agree
on child custody or visitation. The parties shall maintain a meaningful parent/child
relationship with the child (ren) of the parties. SECTION 8. 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.
Husband Initials:___________ Wife Initials: ___________ SECTION 9. 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.The parties acknowledge that they have been advised that there may be certain tax
consequences pertaining to this Agreement and have been directed and advised to obtain
independent tax advice from qualified tax accountants or tax counsel prior to signing
this Agreement, and that each party has had an opportunity to do so. SECTION 10. 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 11.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, and the
enforceability thereof, is not contingent upon either party or both parties being granted a
divorce on any grounds. However, if either or both parties are granted a divorce on any
grounds, the parties agree that this Agreement shall be made a part thereof and that such
decree or judgment shall not conflict with the terms hereof except to the extent
disapproved by the Court. In the event that the law governing this Agreement prohibits
Husband Initials:___________ Wife Initials: ___________this Agreement from being effective until a divorce action has been filed, or a Judgment
of Divorce entered, then the parties agree that such event shall be the effective date of
this Agreement. In the event a divorce action or judgment is required prior to this
Agreement becoming effective, or in the event that a divorce action is desired by one or
more of the parties, both parties agree and sign and execute all pleading and papers
required to obtain a divorce and jointly request and consent to the immediate submission
of this Agreement to the applicable Court and to an entry of a judgment by incorporation
of this Agreement into the final decree or judgment of divorce. SECTION 12. 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 13. 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 Agreeement represents a compromise of
disputed issues; however, both parties believe that its terms and conditions are fair
and reasonable. SECTION 14. 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.
Husband Initials:___________ Wife Initials: ___________Except for those rights and obligations contained in this Agreement, or arising therefromby 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 reliquinsh 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 an entry of a final judgment of divorce,
if any. SECTION 15. 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 16.BANKRUPTCY To the extent of any obligation contained herein is discharged in bankruptcy and the non-
Husband Initials:___________ Wife Initials: ___________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 17. 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 18. 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 19.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 20. CONTROLLING LAW This Agreement shall be governed, enforced and interpreted according to the laws of the
State of West Virginia.
Husband Initials:___________ Wife Initials: ___________ SECTION 21. HEIRS AND ASSIGNS This Agreement shall be binding upon their legal representatives, successor, heirs and
assigns.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.Dated: Signature of Wife Printed Name: _____________________________Address: __________________________________City, State, Zip: Telephone Number: Fax Number: Dated: Signature of Husband Printed Name: Address: City, State, Zip: Telephone Number: Fax Number: STATE OF WEST VIRGINIACOUNTY OF __________________This instrument was acknowledged before me on __________________________ (date)
by _______________________________________________ (name or names of person or persons acknowledging). ___________________________________Notary PublicPrinted Name: ______________________ My Commission Expires: _________________STATE OF WEST VIRGINIACOUNTY OF __________________This instrument was acknowledged before me on __________________________ (date)
by _______________________________________________ (name or names of person or persons acknowledging).
Husband Initials:___________ Wife Initials: ___________ ___________________________________Notary PublicPrinted Name: _______________________ My Commission Expires: _________________
