SEPARATION AGREEMENT

THIS SEPARATION AGREEMENT (the “Agreement”) dated this _____________of _____________, 20___.

BETWEEN:

________________
______________, _____________,
in the State of Pennsylvania, _____________

-and-

________________
______________, _____________,
in the State of Pennsylvania, _____________

BACKGROUND:
1. ________________ and ________________ (collectively the ‘Parties’ and individually a ‘Party’) were lawfully married on ______________ _________, ____________________, in ______________, Pennsylvania. Due to certain differences that have developed between the Parties, they agree to live separate and apart from each other, subject to the terms and conditions in this Agreement.
2. The Parties have made complete, fair and accurate disclosure to each other on all financial matters reflected in this Agreement.
3. The terms of this Agreement are intended to settle the matters addressed, but it will not be incorporated into a final decree of divorce. The Parties agree that a subsequent separation agreement will have to be made and duly incorporated into a final decree of divorce.
4. The Parties have each consulted an attorney with regard to his or her legal rights arising out of the marital relationship and the terms of this Agreement.
5. The Parties have each voluntarily entered into this Agreement and have not been forced by anyone to sign this Agreement, and both Parties confirm that they are in sound mental health.

IN CONSIDERATION OF the mutual promises and covenants contained in this Agreement, and other valuable consideration, the receipt and sufficiency of which consideration is acknowledged, the Parties agree as follows:

LIVING SEPARATE AND APART

1. The Parties have lived separate and apart since ________________________________. Neither Party will attend the other’s living space or work without invitation or approval.

CHILDREN

2. There is one child of the marriage, namely:
   

   Name:	Date of Birth:
   ____________________	_____________ _____________, ____________________

CHILD CUSTODY

3. The Parties agree that sole legal custody is in the best interests of the child. The Parties agree that ________________ is granted sole legal custody, and has the primary right to decide regarding matters of health, education and welfare in the child’s best interests. ________________ may make emergency decisions affecting the health or safety of the child when the child is in her physical care and control. The Parties agree that the grant of sole legal custody to one Party does not deprive the other Party of access to information regarding the children.
4. The Parties agree that the child will primarily reside with ________________.
5. The Parties also agree that ________________ will have the following visitation time with the child:
   1. Regular visitation schedule:
      ______________________________________________
   2. Vacation visitation schedule:
      ______________________________________________

CHILD SUPPORT

6. ________________ will pay child support in the amount of $_________ monthly to ________________. Child support payments will commence on ____________ and will be paid on the _____ day of each and every month.
7. ________________ will pay a total of $_____________ monthly to ________________ for the child’s uninsured health care costs, child care costs, and other additional costs, such as __________________________. Child support payments for these expenses will commence on _______________________ and will be paid on the _____ day of each and every month.
8. The Parties agree that each will provide the other copies of their income tax return and any notices of assessment and re-assessment issued, on an annual basis.
9. ________________ will maintain health insurances, including medical and dental coverage, for the benefit of ____________________.
10. Subject to the laws of Pennsylvania, child support payments, contributions to uninsured health care costs, child care costs, additional costs, and the maintenance of health insurance will continue as long as a child is under the age of majority and financially dependent on the parents.

SPOUSAL MAINTENANCE

11. Neither Party claims entitlement to spousal maintenance. Both Parties expressly waive any claim to spousal maintenance now and in the future, regardless of any change in circumstances experienced by either Party.


ASSETS

12. The Parties acknowledge that they have agreed upon a division of all assets, owned or possessed by them as marital property or separate property. The Parties are in possession of all of those assets to which each is respectively entitled. Accordingly, neither makes any claim to any assets in the possession of the other.

DEBTS

13. The Parties agree that any indebtedness secured against, or attributable to, any item of property that either Party is receiving under this Agreement will be the sole responsibility of the Party receiving the particular property.
14. Neither Party will incur any further debt or liability on the other Party’s credit. Any debt accumulated as of the date of this Agreement is the debt of the individual Party, regardless if the debt was incurred as a result of joint credit.

GENERAL PROVISIONS

15. The Parties will promptly sign and give to the other all documents necessary to give effect to the terms of this Agreement.
16. This Agreement contains the entire agreement between the Parties about their relationship with each other. It replaces any earlier written or oral agreement between the Parties.
17. Should any portion of this Agreement be held by a court of law to be invalid, unenforceable, or void, such holding will not have the effect of invalidating or voiding the remainder of this Agreement, and the Parties agree that the portion so held to be invalid, unenforceable, or void, will be deemed amended, reduced in scope, or otherwise stricken only to the extent required for purposes of validity and enforcement in the jurisdiction of such holding.
18. The Parties may only amend this Agreement in writing after both Parties have obtained legal advice on the changes.
19. In the event that a dispute arises regarding this Agreement, the Parties will try to resolve the matter through negotiation or mediation, prior to initiating a court action.
20. Notwithstanding that the Parties acknowledge and agree that their circumstances at the execution of this Agreement may change for any reason, including but without limiting the generality of the foregoing, the passage of years, it is nonetheless their intention to be bound strictly by the terms of this Agreement at all times.
21. This Agreement creates a fiduciary relationship between the Parties in which each Party agrees to act with the utmost of good faith and fair dealing toward the other in all aspects of this Agreement.
22. The Parties agree to provide and execute such further documentation as may be reasonably required to give full force and effect to each term of this Agreement.
23. The headings of this Agreement form no part of it, and will be deemed to have been inserted for convenience only.
24. This Agreement will be binding upon and will enure to the benefit of the Parties, their respective heirs, executors, administrators, and assigns.
25. If the Parties reconcile, the terms of this Agreement will remain in effect unless the Parties revoke it in writing.
26. This Agreement may only be terminated or amended by the Parties in writing signed by both of them.
27. The laws of the State of Pennsylvania will govern the interpretation of this Agreement, and the status, ownership, and division of property between the Parties wherever either or both of them may from time to time reside.

IN WITNESS WHEREOF the Parties have duly affixed their signatures on this_____________ of _____________, 20___.

ACKNOWLEDGMENT

THE STATE OF PENNSYLVANIA

COUNTY OF____________________

I, Attorney, within and for said County and State, do certify that on this day came before me, ________________, personally known to me, whose name is signed to the foregoing Separation Agreement and so acknowledged his signatures on this Separation Agreement and that ________________ entered into this Separation Agreement on his own free will and volition without force or duress by any Party.

Given my hand and seal this ___ day of ____________________, 20___.

ACKNOWLEDGMENT

THE STATE OF PENNSYLVANIA

COUNTY OF____________________

I, Attorney, within and for said County and State, do certify that on this day came before me, ________________, personally known to me, whose name is signed to the foregoing Separation Agreement and so acknowledged her signatures on this Separation Agreement and that ________________ entered into this Separation Agreement on her own free will and volition without force or duress by any Party.

Given my hand and seal this ___ day of ____________________,20___.