This is an agreement between a husband and wife that intend to end their marriage and
separate permanently. This agreement specifies the custody rights of the parents over
their children. One parent is designated as the custodial parent and will have a majority
of the custody of the children. The other parent will have visitation rights during
designated days and times of the week. This agreement can be used by married
couples that have children and want to reach an amicable custody agreement.
SEPARATION AGREEMENT
WITH SUPPORT AND CUSTODY PROVISIONS
This agreement is made this ______ day of ___________, 20___, [Instruction: insert
date] between __________________ [Instruction: insert name of husband], residing
at _________________________ [Instruction: insert address], here referred to as
“Husband”, and _______________________ [Instruction: insert name of wife],
residing at _______________________________________ [Instruction: insert
address], here referred to as “Wife.”
RECITALS
Husband and Wife recite and declare that:
They were married on the ______ day of ___________, ______ [Instruction: insert
date] in ________________ [Instruction: insert Location and Address] and since
have been and now are husband and wife.
As the result of disputes and unhappy differences occurring and persisting between
them, they have been separated and living apart since the ______ day of ___________,
______ [Instruction: insert date] or have agreed to an immediate and permanent
separation.
A proceeding for dissolution of marriage is now pending or will shortly be filed by
_________________ [Instruction: insert party who initiated the divorce
proceedings; either “Husband” or “Wife”] in __________________ [Instruction:
insert court and location of court].
___________ [Instruction: insert number] children have been born to the parties of
the marriage and are now living. They are listed as follows:
_______________________________________ ______________
Name Age
_______________________________________ ______________
Name Age
_______________________________________ ______________
Name Age
_______________________________________ ______________
Name Age
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[Instruction: insert the names and ages of the children in the spaces provided.
Delete unnecessary spaces or add additional spaces as needed.]
1. _______________ [Instruction: insert either Husband or Wife] shall be the
primary residential parent of the Child (“Custodian”). _______________
[Instruction: insert either Husband or Wife] shall be the non-custodial Parent
(“Non-Custodial Parent”)
2. Non-Custodial Parent shall have the right to visit the Child once each week, on
either of the following days, between the following hours, respectively: (A) on
______________ [Instruction: insert day of the week] between
_________________ [Instruction: insert starting hour] and ______________
[Instruction: insert ending hour] or ______________ [Instruction: insert
alternate starting hour] and ______________ [Instruction: insert alternate
ending hour]; or (B) on ______________ [Instruction: insert day of the week]
between _________________ [Instruction: insert starting hour] and
______________ [Instruction: insert ending hour] or ______________
[Instruction: insert alternate starting hour] and ______________ [Instruction:
insert alternate ending hour]. Further Parties agree to the schedule “Visitation
Schedule” attached hereto.
[Instruction: this section may be amended to accurately reflect the agreement of the
parties]
3. Parties agree that the Non-Custodial Parent will notify the Custodian on or before
___________________________ [Instruction: insert day of the week and time of
day] whether the Non-Custodial Parent intends to visit the Child and on which of the
designated days and times. Should any day or hour selected causes inconvenience,
the Custodian will notify the Non-Custodial Parent no later than
___________________________ [Instruction: insert day of the week and time of
day], and the Non-Custodial Parent shall be permitted to visit the Child the alternate
day or during the alternate hours.
[Instruction: this section may be amended to accurately reflect the agreement of the
parties]
4. Both Partie