LEGAL SEPARATION AGREEMENT FORM SAMPLE 

A marital separation agreement form deals with some major issues including:

Child support, visitation, division of property the couple have accumulated during the marriage, division of debts, pension plans, tax issues, health insurance, cars and other vehicles, stocks and shares,who will live in the house or if the house will be sold,  and issues that might come up at a later date.

It is in your best interest to consult with a competent attorney licensed in your state before using or signing any legal document.


A separation agreement form is not valid in some states unless signed by both parties and the couples signatures are notarized.

LEGAL MARITAL SEPARATION AGREEMENT FORM


THIS AGREEMENT is made and entered into this ____ day of _________ at __________, between _________________, SSN: ______________, Date of birth: _____/____/____, hereinafter referred to as "Husband," and _________________, SSN: ______________, Date of birth: _____/____/____, hereinafter referred to as "Wife," hereby agree to the following:

This Agreement is an agreement settling the above mentioned parties' property and marital rights. The same is not an agreement between the parties to obtain a divorce. 

The terms “Husband” and “Wife” used herein shall refer to the parties herein whether they remain married or become unmarried.

Except as otherwise stated herein, all the provisions of this Agreement shall be binding upon the respective heirs, next of kin, estates, administrators, executors, and assigns of the parties.

“Husband” and “Wife”  were lawfully married on ____________________ in ________________________ County,________________________ (State)

The parties have _____ children as follows:

Name: ____________________ Date of Birth: ___/___/____ Age: _____

Name: ____________________ Date of Birth: ___/___/____ Age: _____

Name: ____________________ Date of Birth: ___/___/____ Age: _____

Name: ____________________ Date of Birth: ___/___/____ Age: _____

Custody and Visitation

The children/child who will be residing with “Wife”:

_______________________________________________________________

_______________________________________________________________

The children/child who will be residing with “Husband”:

_______________________________________________________________

_______________________________________________________________

The children/child who will be residing jointly with Husband and Wife:

_______________________________________________________________

_______________________________________________________________

Child custody will be shared according to the following schedule:

_______________________________________________________________

_______________________________________________________________

Wife will have visitation with the children not in her custody according to the following schedule:

_______________________________________________________________

_______________________________________________________________

Husband will have visitation with the children not in his custody according to the following schedule:

_______________________________________________________________

_______________________________________________________________

Child Support

The ___________ shall pay to the ___________  the amount of $_____________ each and every ____________ (week, month, etc.) as and for the support of the minor child/children of the couple, beginning on __________ and continuing until the child/children reaches majority, dies, marries, enters the armed forces or becomes emancipated by the court.

Personal Property

The "Wife" shall have as her separate personal property:

_______________________________________________________________

_______________________________________________________________

The "Husband" shall have as his separate personal property:

_______________________________________________________________

_______________________________________________________________

Husband and Wife have made an accurate and complete disclosure to each other of all financial matters affecting this agreement.

Other Debt & Expenses

“Husband” will be fully responsible to pay the following debts and expenses:

_______________________________________________________________

_______________________________________________________________

“Wife” will be fully responsible to pay the following debts and expenses:

_______________________________________________________________

_______________________________________________________________

Both, “Husband” and “Wife” will be fully responsible to pay the following debts and expenses:

_______________________________________________________________

_______________________________________________________________

Debts incurred by either party subsequent to the date of signing this agreement will be the sole responsibility of that party.

Insurance

“Wife” will keep life insurance in the amount of $_____________ for the benefit of: ______________________________

“Husband” will keep life insurance in the amount of $_____________ for the benefit of:

______________________________

“Wife” will keep dental and medical insurance for the benefit of: _________________

“Husband” will keep dental and medical insurance for the benefit of: _______________

Spousal Support

The ___________ shall pay to the ___________  the amount of $_____________ each and every ____________ (week, month, etc.) as and for the spousal support, beginning on __________ and continuing until ________________. Or until the spouse remarries, dies or the support is terminated by the court.

“Husband” and “Wife”shall continue to live separate and apart and each shall be free from molestation, interference, authority and control, direct or indirect, by the other as fully as if sole and unmarried, and each may reside at such place or places as he or she may desire.

Neither Husband nor Wife shall call upon or visit the other except by express invitation by one accepted by the other.

Each of the parties may, for his or her separate benefit, engage in any employment, business or profession he or she may choose.

Husband and Wife have each been advised and counseled by their respective attorneys regarding their legal rights as related to this agreement.

The separation agreement will become void if the parties reconcile and reunite.

This Agreement, and the rights and duties of the parties hereunder, shall be construed in accordance with, and governed by, the laws of the State of ____________________________.

Agreed to this __________ day of _____________, ____________.

By:

“Husband” ______________________________

“Wife” __________________________________


Witness ___________________________________

Witness ___________________________________


STATE OF_________________________

COUNTY OF________________________


On ____________________________ before me __________________, the undersigned Notary Public, personally appeared ________________________ and ________________________ who are personally known to me or proved on the basis of satisfactory evidence to be the persons whose name are subscribed to this marital separation agreement form and acknowledged to me that they executed the same in their authorized capacities and that by their signatures on the document the persons or the entity upon behalf of which the persons acted, executed the instrument.


Witness my hand and official seal.


Signature __________________________ 

My Commission Expires ___/___/______


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