Marital Separation Agreement
This Marital Separation Agreement ("Agreement") is entered into on this ____ day of __________, 20__, by and between:
Husband/Partner: _____________________________________
Address: _____________________________________________
City, State, Zip: ____________________________________
and
Wife/Partner: _______________________________________
Address: _____________________________________________
City, State, Zip: ____________________________________
This Agreement is governed by the laws of the State of ___________.
The parties hereby agree as follows:
- Separation Date: The parties agree that their marital separation shall commence on the ____ day of __________, 20__.
- Property Division: The parties have divided their marital property as follows:
- Husband/Partner shall retain: __________________________________
- Wife/Partner shall retain: ____________________________________
- Debt Responsibility: The parties agree to take responsibility for the following debts:
- Husband/Partner shall be responsible for: ______________________
- Wife/Partner shall be responsible for: ________________________
- Child Custody and Support: If applicable, the parties shall agree on the following custody arrangements:
- Primary Custody will be held by: ____________________________
- Visitation Rights will be as follows: ________________________
- Child Support Amount: ____________________________________
- Health Insurance: The parties agree on the following responsibilities regarding health insurance coverage:
- Health Insurance for children will be provided by: __________
- Health Insurance for Husband/Partner will be maintained by: ____
- Health Insurance for Wife/Partner will be maintained by: ______
- Dispute Resolution: Should disputes arise, the parties agree to the following method of resolution:
- Mediation, followed by: _____________________________________
- Arbitration if necessary, governed by rules of: ______________
- Modification of Agreement: This Agreement may be modified only in writing, signed by both parties.
IN WITNESS WHEREOF, the parties have executed this Marital Separation Agreement on the day and year first above written.
Husband/Partner Signature: ___________________________ Date: ___________
Wife/Partner Signature: _____________________________ Date: ___________