Rule 17.100--Form 128 Settlement Agreement for a Dissolution of Marriage with no Minor or Dependent Adult Children Caution: This form may require you to provide protected or confidential information. Use this form only if you and your spouse both agree to the terms of a settlement agreement. If filing electronically and you include protected information on this form, fill out or update the Protected Information Disclosure form (111) if you have not already done so. If filing in paper, you may use form 111 to provide any protected information in full. Do not use this form if: · You and your spouse have children under the age of 18, or · You and your spouse have children 18 years of age or older who still need support. If you do not understand how to use this form, or if you should use this form, talk to an attorney. In the Iowa District Court for County where your case is filed County Upon the Petition of Equity case no. Petitioner Full name: first, middle, last Settlement Agreement for a Dissolution of Marriage with no Minor or Dependent Adult Children and concerning Respondent Full name: first, middle, last 1. Personal Information Fill in all information that you know. If you have been assaulted by your spouse and you fear for your safety, you may leave your address, phone number, and email blank. A. Petitioner's birth year and present residence: Birth year Petitioner's present street address City State ZIP code ( County ) Email address Phone number B. Respondent's birth year and present residence: Birth year Respondent's present street address City State ZIP code ( County ) Email address Phone number November 2013 Rule 17.100--Form 128 Page 1 of 8 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.100--Form 128: Settlement Agreement for a Dissolution of Marriage with no Minor or Dependent Adult Children, continued 2. Agreements We agree to the following: A. Children Check all that are true (1) (2) (3) (4) There are no children under the age of 18 who are children of both Petitioner and Respondent. There are no children under the age of 18 who were adopted or born during this marriage. There are no children 18 years of age or older who still need support. Neither Petitioner nor Respondent is pregnant. B. Breakdown of marriage The marriage is broken down and cannot be saved. C. Counseling Counseling will not save the marriage. D. Waiting period before decree Check one (1) (2) More than 90 days have passed since Respondent was served with an Original Notice. Fewer than 90 days have passed since Respondent was served with an Original Notice, but we want the court to take action right away without a separate hearing. We have no children affected by this action. Neither Petitioner nor Respondent is pregnant. This paper explains how we would like to settle all issues in our divorce. E. Financial affidavits Check one (1) Petitioner or Respondent has filed a Financial Affidavit (124). If you check (1), check a and/or b. a. b. (2) Petitioner has filed a Financial Affidavit. Petitioner certifies that Petitioner has fully disclosed all income and the identity and value of all assets and debts. Respondent has filed a Financial Affidavit. Respondent certifies that Respondent has fully disclosed all income and the identity and value of all assets and debts. We are asking that the court not require us to file Financial Affidavits because: Explain F. Division of personal property Check one (1) We have divided our personal property. Petitioner will keep the personal property in Petitioner's possession. Respondent will keep the personal property in Respondent's possession. If you check (1), skip to G. Our personal property will be divided as follows: Attach additional sheets if necessary. a. Petitioner will get the following as Petitioner's separate personal property: (2) November 2013 Rule 17.100--Form 128 Page 2 of 8 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.100--Form 128: Settlement Agreement for a Dissolution of Marriage with no Minor or Dependent Adult Children, continued b. Respondent will get the following as Respondent's separate personal property: G. Division of real estate For each parcel of real estate you own, provide the following information. Attach a separate sheet for each additional parcel. (1) Ownership of real estate Check one a. b. We do not own any real estate. If you check a, skip to H. We own real estate located at: Street address in the City of State of , County of . This land is described in the deed as follows: , and , (2) The real estate shall be: Check one a. b. c. d. Sold and the profit or debt divided % to Petitioner and to Respondent. Awarded to Petitioner, subject to all liens and mortgages. Awarded to Respondent, subject to all liens and mortgages. Other Explain % (3) Additional real estate Check this box if you are attaching separate sheets for additional parcels of real estate. H. Division of debts Check one (1) (2) There are no debts. We have listed all the debts that we know about and ask that they be divided as follows: Attach additional sheets if necessary. Continued on next page November 2013 Rule 17.100--Form 128 Page 3 of 8 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.100--Form 128: Settlement Agreement for a Dissolution of Marriage with no Minor or Dependent Adult Children, continued a. Petitioner will pay the following debts: i. Business or person to whom a debt is owed (a) (b) (c) (d) (e) ii. Account number, if any Last 4 numbers only iii. Total amount still owed $ $ $ $ $ Check this box if you are attaching a separate sheet listing additional information about Petitioner's debts. b. Respondent will pay the following debts: i. Business or person to whom a debt is owed (a) (b) (c) (d) (e) ii. Account number, if any Last 4 numbers only iii. Total amount still owed $ $ $ $ $ Check this box if you are attaching a separate sheet listing additional information about Respondent's debts. c. For any debt we do not know about, the spouse who made the debt will pay that debt. I. Cash payment We ask that Check one (1) (2) Neither Petitioner nor Respondent pay any money to the other. Petitioner pay Respondent $ and debts by , 20 Month (3) Respondent pay Petitioner $ and debts by , 20 Month Day Year Day Year to equalize the division of property . to equalize the division of property . Continued on next page November 2013 Rule 17.100--Form 128 Page 4 of 8 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.100--Form 128: Settlement Agr