INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.902(f)(1), MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) (12/10) When should this form be used? This form should be used when a Petition for Dissolution of Marriage with Dependent or Minor Child(ren), Florida 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 information? 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, Florida 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 called 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. Instructions for Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (12/10) American LegalNet, Inc. www.FormsWorkFlow.com IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: , Petitioner, and , Respondent. 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 each 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. SECTION 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). Wife shall 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 of Marriage with Dependent or Minor Child(ren) (12/10) American LegalNet, Inc. www.FormsWorkFlow.com ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE Current Fair (To avoid confusion at a later date, describe each item as clearly as possible. You do Market Value 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.) = = 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 of Marriage with Dependent or Minor Child(ren) (12/10) American LegalNet, Inc. www.FormsWorkFlow.com ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE Current Fair (To avoid confusion at a later date, describe each item as clearly as possible. You do Market Value 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.) = = Sporting and entertainment (T.V., stereo, etc.) equipment Other assets Total Assets to Wife $ 1. 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 Current Fair (To avoid confusion at a later date, describe each item as clearly as possible. You do Market Value 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.) = = 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 of Marriage with Dependent or Minor Child(ren) (12/10) American LegalNet, Inc. www.FormsWorkFlow.com ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE Current Fair (To avoid confusion at a later date, describe each item as clearly as possible. You do Market Value 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.) = = 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 of Marriage with Dependent or Minor Child(ren) (12/10) American LegalNet, Inc. www.FormsWorkFlow.com 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 (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.) = = Mortgages on real estate: (Home) Current Amount Owed Monthly Payment $ $ $ $ (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 of Marriage with Dependent or Minor Child(ren) (12/10) American LegalNet, Inc. www.FormsWorkFlow.com 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 (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.) = = Mortgages on real estate: (Home) Current Amount Owed Monthly Payment $ $ $ $ (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 of Marriage with Dependent or Minor Child(ren) (12/10) American LegalNet, Inc. www.FormsWorkFlow.com SECTION II. SPOUSAL SUPPORT (ALIMONY) (If you have not agreed on this matter, write n/a on the lines provided.) [ Choose only one] 1. ___Each of us forever gives up any right to spousal support (alimony) that we may have. 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 (such as temporary, permanent, rehabilitative, and/or lump sum) and any other specifics: [Choose if applicable] ( ) Life insurance in the amount of $ support, will be provided by the obligor. to secure the above SECTION III. PARENTING PLAN ESTABLISHING 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. ( ) Mother ( ) Father 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 Family Law Rules of Procedure Form 12.902(e), is completed and attached. This parent shall be obligated to pay child support in the amount of $ , every ( ) week ( ) other week ( ) month, beginning {date} and continuing until : ( ) modification by court order, ( )the youngest child turns 18, becomes emancipated, marries, joins the armed services, dies, or, ( )if after the age of 18, until {date} __ . If the child support amount above Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (12/10) American LegalNet, Inc. www.FormsWorkFlow.com 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 unpaid 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. ( ) Mother ( ) Father 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 not reasonable in cost and 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 both parents. b. ___Prorated according to the child support guideline percentages. c. ___Other {explain}: ______________________________________________________ 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. ( ) Mother ( ) Father 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 not reasonable in cost and 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 both parents. 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 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. 5. Life Insurance. ( ) Mother ( ) Father shall be required to maintain life insurance coverage for until the youngest child the benefit of the parties’ minor child(ren) in the amount of $ turns 18, becomes emancipated, marries, joins the armed services,or dies. 6. IRS Income Tax Deduction(s). The assignment of any tax deductions for the child(ren) shall be as follows: {explain} ______________________________________________________________ ______________________________________________________________________________ The other parent will convey any applicable IRS form regarding the income tax deduction. Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (12/10) American LegalNet, Inc. www.FormsWorkFlow.com 7. Other provisions relating to child support (e.g., uninsured medical/dental expenses, health or dental insurance , life insurance to secure child support, orthodontic payments, college fund, etc.): ________________________________________________________________________ SECTION V. OTHER 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: Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (12/10) American LegalNet, Inc. www.FormsWorkFlow.com 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 BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} a nonlawyer, located at {street} , {city} , , {phone} , helped {name} {state} petitioner or respondent, fill out this form. who is the [Choose only one] , , 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: Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (12/10) American LegalNet, Inc. www.FormsWorkFlow.com 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 BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} , a nonlawyer, located at {street} , {city} , , {phone} , helped { name} , {state} petitioner or respondent, fill out this form. who is the [Choose only one] Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren) (12/10) American LegalNet, Inc. www.FormsWorkFlow.com