IN THE SUPERIOR COURT OF FULTON COUNTY STATE OF GEORGIA FAMILY DIVISION Petitioner: _________________________ , and Civil Action File No.: Judge Respondent:________________________, SEPARATION AGREEMENT This is an Agreement by and between _______________________ (hereinafter referred to as “Wife”) and ______________________ (hereinafter referred to as “Husband”). WITNESSETH: WHEREAS, the parties are married but are currently living in a bona fide state of separation; WHEREAS, there has/have been _______child (ren) born as issue of the marriage, to wit: ______ ; WHEREAS, the parties desire to settle between themselves all questions of division of property, child custody, visitation, child support, alimony, and all other rights and obligations arising out of their marital relationship; NOW THEREFORE, in consideration of the mutual covenants hereinafter contained, the parties agree as follows: 1. The parties shall continue to live separate and apart and each shall be free from interference, Page 1 of 7 Separation Agreement © 2007 Fulton County Superior Court Family Division American LegalNet, Inc. www.FormsWorkflow.com molestation, 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 select. 2. (Check a, b, or c) □ a) The □ Husband / □Wife shall have the temporary and permanent legal and physical custody of the minor child(ren) born as issue of the marriage. □ b) The Husband and Wife shall share joint legal custody of the minor child(ren). The parties shall share decision-making concerning the children; however, the □ Husband/ □Wife shall have the right to make the final decision in the event the parties cannot agree. Primary physical custody of the minor child (ren) shall be with the □ Husband/ □Wife as follows: Secondary physical custody shall be with the □ Husband / □Wife as follows: □ c) The Husband and Wife shall share joint legal custody and joint physical custody of the minor child (ren). Physical custody shall be shared by the parties as follows: The parties shall share decision making concerning the child(ren); however, in the event the Page 2 of 7 Separation Agreement © 2007 Fulton County Superior Court Family Division American LegalNet, Inc. www.FormsWorkflow.com parties cannot decide, the □ Husband/ □Wife shall have the final decision concerning the following: _______________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 3. The □ Husband/□ Wife shall have the right of visitation with the minor child(ren) as follows: OR as set out in the Visitation Schedule attached hereto and incorporated herein. 4. The parties agree that the welfare of the child(ren) is of paramount importance and each agrees to foster a feeling of affection between themselves and the child(ren). Neither party shall do anything to hamper the natural development of the child(ren)’s love and respect for the other party. 5. NOTICE NOTICE NOTICE The new Georgia Child Support Guidelines went into effect on 1/1/07. Any child support calculations must now be made using the new guidelines. To obtain the forms and instructions, go to: https://services.georgia.gov/dhr/cspp/do/public/SupportCalc or go back to the menu section of this packet for a link to the site. a) The □ Husband/□ Wife shall pay to the□ Husband/□ Wife, as support of the minor child (ren), the sum of _________________Dollars per □ week/ □bi-weekly/ □semi-monthly/ □monthly, for a total of ____________ Dollars to be paid per □ week/ □bi-weekly/ Page 3 of 7 Separation Agreement © 2007 Fulton County Superior Court Family Division American LegalNet, Inc. www.FormsWorkflow.com □semi-monthly/ □monthly starting on _______________________, 20___, and continuing per □ week/ □bi-weekly/ □semi-monthly/ □monthly thereafter until the child reaches the age of eighteen, marries, dies, or otherwise becomes emancipated or so long as the child is enrolled in and attending secondary school not to exceed age 20. The child support obligation shall be □ reduced as follows: occurrence. _________________ / □ terminated in the event of said b) All payments of child support shall be paid as follows (If you have an Income Deduction Order, payments must be paid into the Family Support Registry.): (Check 1 or 2) □ 1) Directly to the □ Wife □Husband at the following address: No Income Deduction Order will be entered into at this time. □ 2) To the Family Support Registry pursuant to an Income Deduction Order. (Make sure to complete the Income Deduction Order packet.) 6. The □Wife/ □Husband shall maintain a policy of medical, dental, and hospitalization insurance for the benefit of the minor child (ren) for so long as the child support obligation set forth herein exists. Costs not covered under the insurance policy shall be provided as follows: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ The □ Wife/ □Husband shall provide the □ Wife/ □Husband with an insurance identification card or such other acceptable proof of insurance coverage and shall cooperate with □ Wife! □Husband in submitting claims under the policy. Page 4 of 7 Separation Agreement © 2007 Fulton County Superior Court Family Division American LegalNet, Inc. www.FormsWorkflow.com 7. (Check a or b) □ a) The □ Wife/ □Husband shall pay to the □ Wife/ □Husband as alimony, the sum of _______________________________ Dollars per __________to be paid_____________ beginning on the ________ day of _____________ , and continuing __________________ thereafter until the Wife/ □Husband remarries or dies. □ b) The parties hereby expressly waive alimony for past, present, and future. 8. (Check a or b) □ a) The parties acknowledge that they have previously made a division of their household furniture, furnishings, household goods, equipment and other such personalty. Neither party shall claim any of the property in the possession of the other as of the date of the signing of this agreement. □ b) The parties acknowledge that they possess various items of jointly owned property, which shall be divided as follows: 1) To the Wife 2) To the Husband __________________________________________________________ __________________________________________________________ __________________________________________________________ Page 5 of 7 Separation Agreement © 2007 Fulton County Superior Court Family Division American LegalNet, Inc. www.FormsWorkflow.com 9. (Check a or b) □ a) The parties acknowledge that they have no outstanding joint debts. □ Husband’s initials_____ □ b) □Wife’s initials_____ The parties acknowledge that they have the following joint debts: Creditor Amount of debt _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ 1) The Husband shall be responsible for the following debts: _____________________________________________________ _____________________________________________________ _____________________________________________________ and indemnifies and holds the Wife harmless for any collections on those obligations. 2) The Wife shall be responsible for the following debts: _____________________________________________________ _____________________________________________________ _____________________________________________________ and indemnifies and holds the Husband harmless for any collection on those obligations. 10. The parties acknowledge that they have entered into this Agreement freely and voluntarily and that it is not the result of any duress of any undue influence. 11. The Agreement constitutes the entire understanding of the parties. There are no representations, warranties, covenants, or undertakings other than those expressly set forth herein. Page 6 of 7 Separation Agreement © 2007 Fulton County Superior Court Family Division American LegalNet, Inc. www.FormsWorkflow.com 12. It is expressly understood that this Agreement does not obligate the parties to continue to live in a state of separation or to proceed with an action for divorce. However, in the event that either party shall bring or maintain an action for dissolution of the marital relationship, this Agreement shall be presented to the court and incorporated by reference into any judgment or decree concerning the matters provided herein. Notwithstanding such incorporation, this Agreement shall survive and be enforceable independently of the judgment or decree. IN WITNESS WHEREOF, the parties have signed their names, this _______________ day of __________________, 20____ as to the Wife and this ___________________ day of ____________________, 20___ as to the Husband. ____________________________ Wife Sworn and subscribed before me this the ____ day of __________________, 20____. _____________________________________ NOTARY PUBLIC My commission expires: ____________________________ Husband Sworn and subscribed before me this the ____ day of __________________, 20____. _____________________________________ NOTARY PUBLIC My commission expires: Page 7 of 7 Separation Agreement © 2007 Fulton County Superior Court Family Division American LegalNet, Inc. www.FormsWorkflow.com