Marital Settlement Agreement Form
In case of a marital agreement settlement that doesn’t involve children, the following form has to be used in order to negotiate and finalize the settlement.
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Instructions for Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with D epe ndent or Minor Child(ren) (05/12 ) INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.902(f)(1), MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE WITH DEPE NDENT OR MINOR CHILD(REN) (05/12 ) When should this form be used? This form should be used when a Petition for Dissolution of Marriage with Dependent or Minor Child(ren) , Flor ida Supreme Court Approved Family Law Form 12.901(b)(1), has been filed and the parties have reached an agreement on some or all of the issues at hand. This form should be typed or printed in black ink. Both parties must sign the agreement and have their signatures witnessed by a notary public or deputy clerk . After completing this form, you should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. You should then refer to the instructions for your petition, answer , or answer and counterpetition concerning the procedures for setting a hearing or trial (final hearing ). Where can I look for more informatio n? Before proceeding, you should read General Information for Self -Represented Litigants found at the beginning of these forms. The words that are in bold underline in these instructions are defined there. For further information, see chapter 61, Florid a Statutes, and the instructions for the petition and/or answer that were filed in this case. Special notes... With this form you must also file a Child Support Guidelines Worksheet , Florida Family Law Rules of Procedure Form 12.902(e), if not already filed. This form does not act to transfer title to the property. Such transfer must be done by deed or supplemental final judgment. Remember, a person who is NOT an attorney is calle d a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution o f Marriage with D epe ndent or Minor Child(ren) (05/12 ) IN THE CIRCUIT COURT OF THE _______________________________JUDICIAL CIRCUIT, IN AND FOR ______________________________ COUNTY, FLORIDA Case No.: _____________________________________ Division: ________ ______________________________ In re: the Marriage of: ____________________________, Husband, and ____________________________, Wife. MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) We, {Husband’ s full legal name} ________________________________________ , and {Wife’s full legal name ,_________________________________ being sworn, certify that the following statements are true: 1. We were married to each other on {date} ________________________________________ . 2. Because of irreconcilable differences in our marriage (no chance of staying together), we have made this agreement to settle once and for all what we owe to each other and what we can expect to receive from ea ch other. Each of us states that nothing has been held back, that we have honestly included everything we could think of in listing our assets (everything we own and that is owed to us) and our debts (everything we owe), and that we believe the other has been open and honest in writing this agreement. 3. We have both filed a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). Because we have voluntarily made full and fair disclosure to each other of all our assets and debts, we waive any further disclosure under rule 12.285, Florida Family Law Rules of Procedure. 4. Each of us agrees to execute and exchange any papers that might be needed to complete this agreement, including deeds, title certificates, etc. SECTI ON I. MARITAL ASSETS AND LIABILITIES A. Division of Assets. We divide our assets (everything we own and that is owed to us) as follows: Any personal item(s) not listed below is the property of the party currently in possession of the item(s). 1. Wife sha ll receive as her own and Husband shall have no further rights or responsibilities regarding these assets: Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution o f Marriage with D epe ndent or Minor Child(ren) (05/12 ) ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE (Please 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.) Furniture & furnishings in home Furniture & furnishings elsewhere Collectibles Jewelry Life insurance (cash surrender value) Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution o f Marriage with D epe ndent or Minor Child(ren) (05/12 ) ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE (Please 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 Sporting and entertainment (T.V., stereo, etc.) equipment Other assets Total Assets to Wife $ 2. 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 (Please describe each item as clearly as possible. You do not need to list account num bers. 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 Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution o f Marriage with D epe ndent or Minor Child(ren) (05/12 ) ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE (Please describe each item as clearly as possible. You do not need to list account num bers. Where applicable, include whether the name on any title/deed/account described below is wife’s, husband’s or both.) Current Fair Market Value 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 Total Assets to Husband $ __________ Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution o f Marriage with D epe ndent or Minor Child(ren) (05/12 ) B. Division of Liabilities/Debts. We divide our liabilities (everything we owe) as follows: 1. 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 (Please describe each item as cle arly 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 Payment Current 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 Total Debts to Be Paid by Wife $ ________ $ _______ Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution o f Marriage with D epe ndent or Minor Child(ren) (05/12 ) 2. 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 (Please 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 Payment Current 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 Total Debts to Be Paid by Husband $ ________ $ _______ C. Contingent Assets and Liabilities (listed in Section III of our Family Law Financial Affidavits) will be divided as follows: Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution o f Marriage with D epe ndent or Minor Child(ren) (05/12 ) SECTION II. SPOUSAL SUPPORT (ALIMONY) (If you have not agreed on this matter, write n/a on the lines provided.) 1. ___Each of us forever gives up any right to spousal support (alimony) that we may have. OR 2. ___ ( ) HUSBAND ( ) WIFE (hereinafter “Obligor”) 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 (such as, permanent, bridge -the -gap, d urational, rehabilitative, and/or lump sum) and any other specifics: 3. Other provisions relating to alimony, including any tax treatment and consequences: _____________________________________________________________________________ ______________________________________________________________________________ 4. { _____Indicate if applicable} Life insurance in the amount of $__________ to secure the above support, will be provided by the Obligor. SECTION III. PARENTING PLAN ESTAB LISHING PARENTAL RESPONSIBILITY AND TIME -SHARING 1. The parties’ minor child(ren) are: Name Birth date 2. The parties shall have time -sharing and parental responsibility in accordance with the Parenting Plan attached as Exhibit _____. SECTION IV. CHILD SUPPORT 1. ( ) Wife ( ) Husband (hereinafter “Obligor”) will pay child support, under Florida’s child support guidelines, section 61.30, Florida Statutes, to the other parent. The Child Support Guidelines Worksheet, Florida Famil y Law Rules of Procedure Form 12.902(e), is completed and attached. Child support in the amount of $_________ for the ________children { total number of parties’ minor or dependent children} shall be paid commencing_________________ {month, day, year} and te rminating ___________________ {month, day, year}. Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution o f Marriage with D epe ndent or Minor Child(ren) (05/12 ) Upon the termination of the obligation of child support for one of the parties’ children, child support in the amount of $____________ for the remaining __________children {total number of remaining childre n} shall be paid commencing_____________________ {month, day, year} and terminating __________________________ {month, day, year}. {Insert schedule for the child support obligation, including the amount, commencement, and termination dates for the remainin g minor or dependent children, which shall be payable as the obligation for each child ceases. Please indicate whether the schedule ____appears below or ____ is attached as part of this form.} ______________________________________________________________ _______________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ______ _______________________________________________________________________ _____________________________________________________________________________ The Obligor shall pay child support until all the minor or dependent child(ren): reach the age of 18; bec ome emancipated, marry, join the armed services, die, or become self -supporting; or until further order of the court or agreement of the parties. The child support obligation shall continue beyond the age of 18 and until high school graduation for any chi ld who is: dependent in fact; between the ages of 18 and 19; and is still in high school, performing in good faith with a reasonable expectation of graduation before the age of 19. Child support shall be payable ( ) at least once a month and in accordan ce with the parent(s)’s employer(s)’s payroll cycle, or ( ) other {explain} ______________________________________. If the child support amount above deviates from the guidelines by 5% or more, explain the reason(s) here: ______________________________________________________________________________ _______________________________________________________________________ _______ ______________________________________________________________________________ 2. Child Support Arrearage. There currently is a child support arrearage of $ ___________ for retroactive child support and/or $___________ for previously ordered unp aid child support. The total of $ ___________ in child support arrearage shall be repaid at the rate of $ ___________ every ( ) week ( ) other week ( ) month, beginning {date}_____________ , until paid in full including statutory interest. 3. Health Insurance. ( ) Wife ( ) Husband will maintain health insurance for the parties’ minor child(ren). The party providing coverage will provide insurance cards to the other party showing coverage. OR ( ) Health insurance is either not reasona ble in cost or accessible to the child(ren) at this time. Any uninsured/ unreimbursed medical costs for the minor child(ren) shall be assessed as follows: a. ___Shared equally by husband and wife. b. ___Prorated according to the child support guideline percentages. c. ___Other {explain} : _________________________________________________________ Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution o f Marriage with D epe ndent or Minor Child(ren) (05/12 ) As to these uninsured/unreimbursed medical expenses, the party who incurs the expense shall submit a request for reimbursement to the other party within 30 days, and the other party, within 30 days of receipt, shall submit the applicable reimbursement for that expense, according to the schedule of reimbursement set out in this paragraph. 4. Dental Insurance. ( ) Wife ( ) Husband will maintain ( ) dental insurance for the parties’ minor child(ren). The party providing coverage will provide insurance cards to the other party showing coverage. OR ( ) dental insurance is either not reasonable in cost or accessible to the child(ren) at this time. Any uninsured/ unreimbursed dental costs for the minor child(ren) shall be assessed as follows: a. ___Shared equally by husband and wife. b. ___Prorated according to the child support guideline percentages. c. ___Other {explain} : _________________________________________________________ As to these uninsured/unreimbursed dental expenses, the party who incurs the expense shall submit a request for reimbursement to the other party within 30 days, and the other pa rty, within 30 days of receipt, shall submit the applicable reimbursement for that expense, according to the schedule of reimbursement set out in this paragraph. 5. Life Insurance. ( ) Wife ( ) Husband shall be required to maintain life insurance c overage for the benefit of the parties’ minor child(ren) in the amount of $ ___________until the youngest child turns 18, becomes emancipated, marries, joins the armed services ,or dies. 6. IRS Income Tax Deduction(s). The assignment of any tax deductio ns for the child(ren) shall be as follows: {explain} ____________________________________________________________ _____________________________________________________________________________ The other parent will convey any applicable IRS form regarding the income tax deduction. 7. Other provisions relating to child support (e.g., uninsured medical/dental expenses, health or dental insurance, life insurance to secure child support, orthodonti c payments, college fund, etc.): SECTION V. OTHER Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution o f Marriage with D epe ndent or Minor Child(ren) (05/12 ) SECTION VI. We have not agreed on the following issues: 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 Husband Printed Name: Address: City, State, Zip: Telephone Number: Fax Number: Email Address:_______________________________ STATE OF FLORIDA COUNTY OF ________________________ Sworn to or affirmed and signed before me on _______________by . NOTARY PUBLIC or DEPUTY CLERK [Print, type, or stamp commissioned name of notary or clerk.] ____ Personally known ____ Produced identification Type of identification produced Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution o f Marriage with D epe ndent or Minor Child(ren) (05/12 ) IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] T his form was prepared for the: {choose only one } ( ) Husband ( ) Wife This form was completed with the assistance of: {name of individual} _________________________________________________________________, {name of business} __________________________________________________________________, {address} _____________________________________________________________________, {city} _________________________, {state} _____, {telephone number} _________________________, I cert ify 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: Email Address:________________________________ STATE OF FLORIDA COUNTY OF ___________________________ Sworn to or affirmed and signed before me on _________________ by . NOTARY PUBLIC or DEPUTY CLERK [Print, type, or stamp commissioned name of notary or clerk.] ____ Personally known ____ Produced identification Type of identification produced ____________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BEL OW: [fill in all blanks] This form was prepared for the: {choose only one } ( ) Husband ( ) Wife This form was completed with the assistance of: {name of individual} __________________________________________________________________, {name of business} ____________________________________________________________________, {address} ______________________________________________________________________, {city} ___________________________, {state} ____________ {telephone number} _________________.
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