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Back to Forms for 'Husband and Wife'.




____________________________________________________ (name and address) referred to herein as Husband and _________________________________________ (name and address) referred to as Wife, agree:


The parties were lawfully married on ___________________ (month & day), _________ (year), at _________________________________________________ (name and location).  Difficulties have occurred between the parties, and they have agreed to live separate and apart.


The parties nevertheless desire to resolve certain issues and consequently, have entered into this agreement.


The parties have children born of this marriage who are as follows:


1).  __________________________  ________  _________________

      (Name)                                           (Age)         (Date of Birth)


2).  _________________________  _________  _________________

       (Name)                                        (Age)           (Date of Birth)


3).  _________________________  _________  _________________

      (Name                                           (Age)           (Date of Birth)


The parties have made a complete disclosure to one another of financial matters and each is satisfied that they have had sufficient disclosure of the parties individual and joint finances.


The parties have each been advised by counselors of their own choice regarding their legal rights and any disclosures made herein.


The husband shall assume the following debts and shall not hold the wife responsible for the same:





The wife shall assume the following debts and shall not hold the husband responsible for the same:





Neither party shall incur any further debts which may result in joint liability.  In the event that either party incurs a debt on joint credit of the parties, that party shall be responsible for the total amount of that debt.


As child support, ________________ (husband/wife) shall pay support ____________ (weekly, monthly) the amount of ______________________ Dollars ($__________).


The (husband/wife) shall maintain health insurance for the benefit of ____________

______________________________________ (child(ren) name(s)).


Personal property of the parties shall be divided as follows:


The Husband shall have the following property: _______________________________



The Wife shall have the following property: ___________________________________




If any debts are associated with the items of property divided herein, the party receiving the same shall assume the debt and hold the other party harmless from such debts.


Any property not specifically divided herein shall be subject to distribution at a later time.


The ____________________ (husband/wife) shall have temporary possession of the residence owned by the parties located at ____________________________________.


Expenses related to the residence shall be borne by the parties as follows:


Husband: _____________________________________________________________



Wife: ________________________________________________________________



The parties agree that this agreement is intended to be a final disposition of the matters agreed upon herein.  This agreement may be introduced into evidence and incorporated in a final decree of dissolution of marriage.  In the event that any disputes occur regarding this agreement, the prevailing party shall be entitled to reasonable attorney’s fees regarding such enforcement.


_________________________                                           ____________________

(Signature of Husband)                                                          (Date)


_________________________                                           ____________________

(Signature of Wife)                                                                (Date)



_________________________                                           ____________________

(Witness for Husband)                                                           (Date)


_________________________                                           ____________________

(Witness for Wife)                                                                 (Date)



________________________                                 My commission expires on:

(Notary Public)



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