Ohio Separation Agreement PDF

IN THE COURT OF COMMON PLEAS ___________________________ DIVISION ___________________________ COUNTY, OHIO Case No. Name Judge Street Address...

IN THE COURT OF COMMON PLEAS ___________________________ DIVISION ___________________________ COUNTY, OHIO Case No. Name Judge Street Address Magistrate City, State and Zip Code Plaintiff/Petitioner 1 vs./and Name Street Address City, State and Zip Code Defendant/Petitioner 2 WARNING: This form is not a substitute for the benefit of the advice of legal counsel. It is highly recommended that you consult an attorney. Instructions: This form is used to present an agreement to the Court regarding spousal support, the division of personal property, real estate, and debts resulting from the termination of marriage. If the parties have any minor child(ren) or child(ren) with disabilities, a Shared Parenting Plan (Uniform Domestic Relations Form 20) or Parenting Plan (Uniform Domestic Relations Form 21) must be attached. The Court may require additional forms to accompany this document. You must check the requirements of the county in which you file. YOU MUST UPDATE THE CLERK OF COURTS IF ANY OF THE ABOVE CONTACT INFORMATION CHANGES. SEPARATION AGREEMENT The parties, ___________________________ and ___________________________, state as follows: 1. The parties were married on (date of marriage) in (city or county, and state). 2. The parties request that the termination of marriage be the date of the final hearing or the date specified:. Supreme Court of Ohio Uniform Domestic Relations Form 19 SEPARATION AGREEMENT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Page 1 of 14  3. The parties intend to live separate and apart. 4. Each party completed (a) financial disclosure affidavit(s) which fully and accurately lists and values all marital property, separate property, and any other assets, debts, income, and expenses. 5. Each party acknowledges that he/she reviewed the other party’s completed financial disclosure affidavit(s). 6. Each party’s financial disclosure affidavit(s) shall be filed in the Court’s Family File pursuant to Sup.R. 44(C)(2)(h) no later than the date upon which this Agreement is filed. 7. Neither party has knowledge of any other property or debts of any kind in which either party has an interest. 8. Each party had the opportunity to value and verify all marital property, separate property, and debts. 9. A party’s willful failure to disclose may result in the Court awarding the other party three (3) times the value of the property, assets, income, or expenses that were not disclosed. 10. This Agreement addresses spousal support, property, and debt division. 11. This Agreement is the complete agreement of the parties. 12. There are no other representations, agreements, statements, or prior writings that shall have any effect on this Agreement. 13. Each party fully understands this Agreement and has knowingly and voluntarily signed this Agreement. 14. No change to the terms of this Agreement shall be valid unless in writing and knowingly and voluntarily signed by both parties and incorporated into a Court order. The parties agree as follows: FIRST: SEPARATION The parties shall live separate and apart. Neither party shall interfere with the activities, personal life, or privacy of the other, harass the other, or engage in any conduct calculated to restrain, embarrass, injure, or hinder the other in any way. SECOND: PROPERTY Marital property is defined in R.C. 3105.171. Generally, marital property is property acquired during the marriage which is owned by either or both spouses and property in which either spouse has an interest. Separate property is defined in R.C. 3105.171. Generally, separate property is property that was inherited, acquired by one spouse prior to the date of marriage, acquired after a decree of legal separation under R.C. 3107.17, excluded by a valid antenuptial agreement, received as compensation for personal injury, (except for loss of marital earnings and compensation for expenses paid from marital assets), or any gift of property that was given to only one (1) spouse. Supreme Court of Ohio Uniform Domestic Relations Form 19 SEPARATION AGREEMENT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Page  of 14 A. Real Estate: (select one) Real estate includes, but is not limited to, land, mortgaged properties, buildings, fixtures attached to buildings, attached structures (for example, garage, in-ground pool), condominiums, time shares, mobile homes officially converted to real estate, natural condition stakes (for example, gas, oil, mineral rights, existing soil, including trees and landscape), and remainder rights in real estate. 1. Neither party has any ownership interest in any real estate. 2. One or both of the parties has/have an interest in real estate and agree to distribute the interest(s) as follows: Address or Parcel Number of Property Party 3. A legal description of the property (found in the property’s deed) should be attached. 4. Each party shall pay and hold the other harmless from any debt, including mortgages, real estate taxes and assessments, and other liens owing on real estate received unless otherwise stated in this Agreement. 5. Other arrangements regarding real estate, including, but not limited to, refinancing or sale: If the real estate is not in the name of the party to whom it is distributed, the parties shall transfer the property to the proper party no later than thirty (30) days after filing the Final Judgment Entry unless otherwise provided in this Agreement. B. Titled Vehicles: (select one) Titled vehicles include, but are not limited to, boats, trailers, automobiles, motorcycles, trucks, mobile homes not officially converted to real estate, golf carts, motor scooters, sport utility vehicles (SUV), recreational vehicles (RV), and all purpose vehicles (APV). Provide vehicle year, make, model, and vehicle identification or serial number (VIN/SN) for all titled vehicle(s). 1. Neither party has any ownership interest in any titled vehicle(s). 2. Plaintiff/Petitioner 1 shall receive the following titled vehicle(s) free and clear of any claim of Defendant/Petitioner 2: Year Make Model VIN/SN Supreme Court of Ohio Uniform Domestic Relations Form 19 SEPARATION AGREEMENT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Page  of 14  3. Defendant/Petitioner 2 shall receive the following titled vehicle(s) free and clear of any claim of Plaintiff/Petitioner 1 Year Make Model VIN/SN 4. Each party shall pay and hold the other harmless from any debt owing on the titled vehicle(s) received unless otherwise stated in this Agreement. 5. Other arrangements regarding titled vehicles, including, but not limited to, refinancing or sale: If any vehicle’s title is not in the name of the party to whom it is distributed, the current title holder shall transfer that title to the proper party no later than thirty (30) days after filing the Final Judgment Entry unless otherwise provided in this Agreement. If title cannot be transferred immediately to the party to whom the vehicle is distributed, the party holding the title shall make the following arrangements to obtain and pay for license plates, registration, and insurance: C. Household Goods and Personal Property: (select one) Household goods and personal property include, but are not limited to, pets, appliances, electronics, tools, air conditioner window units, doghouses, lawn mowers, above-ground pools, safety deposit boxes, jewelry, furniture, firearms, silverware, collections, china, and books. 1. The parties divided all of their household goods and personal property. Each party shall retain all household goods and personal property in his/her possession. The parties are satisfied with the division. 2. The parties divided all of their household goods and personal property. Each party shall retain all household goods and personal property in his/her possession, except as follows: Plaintiff/Petitioner 1 shall receive: Supreme Court of Ohio Uniform Domestic Relations Form 19 SEPARATION AGREEMENT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Page  of 14  Defendant/Petitioner 2 shall receive: 3. Delivery or pick-up of household goods and personal property shall be as follows: 4. Each party shall pay and hold the other harmless from any debt owing on the household goods and personal property he/she receives unless otherwise stated in this Agreement. 5. Other arrangements regarding household goods and personal property: D. Financial Accounts: (select one) Financial accounts include, but are not limited to, checking, savings, certificates of deposit, money market accounts, medical or health savings accounts, education or college saving plans (for example, 529 Plan), and trusts. 1. Neither party has any ownership interest in any financial accounts. 2. Plaintiff/Petitioner 1 shall receive the following: Institution Current Name(s) Type of Account on Account checking saving other: checking saving other: checking saving other: Supreme Court of Ohio Uniform Domestic Relations Form 19 SEPARATION AGREEMENT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Page  of 14  3. Defendant/Petitioner 2 shall receive the following: Institution Current Name(s) Type of Account on Account checking saving other: checking saving other: checking saving other: 4. Each party shall pay and hold the other harmless from any debt owing on the financial accounts he/she receives unless otherwise stated in this Agreement. 5. Other arrangements regarding financial accounts: If any financial account is not held in the name of the party to whom it is distributed, the parties shall transfer the financial account to the proper party no later than thirty (30) days after filing the Final Judgment Entry unless otherwise provided in this Agreement. E. Stocks, Bonds, Securities, and Mutual Funds: (select one) 1. Neither party has an interest in any stocks, bonds, securities, or mutual funds. 2. Plaintiff/Petitioner 1 shall receive the following: Institution Current Name(s) Quantity and Description on Account 3. Defendant/Petitioner 2 shall receive the following: Institution Current Name(s) Quantity and Description on Account Supreme Court of Ohio Uniform Domestic Relations Form 19 SEPARATION AGREEMENT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Page  of 14  4. Each party shall pay and hold the other harmless from any debt owing on the stocks, bonds, securities, or mutual funds he/she receives unless otherwise stated in this Agreement. 5. Other arrangements regarding the stocks, bonds, securities, or mutual funds: If any stock, bond, security, or mutual fund is not in the name of the party to whom it is distributed, the parties shall transfer the stock, bond, security, or mutual fund to the proper party no later than thirty (30) days after filing the Final Judgment Entry unless otherwise provided in this Agreement. F. Business Interests: (select one) 1. Neither party has any interest in any business. 2. Plaintiff/Petitioner 1 shall receive the following: Name of Business Ownership Interest 3. Defendant/Petitioner 2 shall receive the following: Name of Business Ownership Interest 4. Each party shall pay and hold the other harmless from any debt owing on the business interests he/she receives unless otherwise stated in this Agreement. 5. Other arrangements regarding business interests: If any business is not in the name of the party to whom it is distributed, the parties shall transfer the business to the proper party no later than thirty (30) days after filing the Final Judgment Entry unless otherwise provided in this Agreement. G. Pension, Profit Sharing, IRA, 401(k), Deferred Compensation, and Other Retirement Plans: (select one) 1. Neither party has any interest in any pension, profit sharing, IRA, 401(k), deferred compensation, or other retirement plans. Supreme Court of Ohio Uniform Domestic Relations Form 19 SEPARATION AGREEMENT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Page  of 14  2. Plaintiff/Petitioner 1 shall receive the following: Institution Name(s) on Plan Amount/Share 3. Defendant/Petitioner 2 shall receive the following: Institution Name(s) on Plan Amount/Share 4. Each party shall pay and hold the other harmless from any debt owing on any pension, profit sharing, IRA, 401(k), deferred compensation, or other retirement plans he/she receives unless otherwise stated in this Agreement. 5. Other arrangements regarding pension, profit sharing, IRA, 401(k), deferred compensation, or other retirement plans: The parties shall arrange the transfer of any distributed interest in any pension, profit sharing, IRA, 401(k), deferred compensation, or other retirement plans to the proper party no later than thirty (30) days after filing the Final Judgment Entry unless otherwise provided in this Agreement. A Qualified Domestic Relations Order (QDRO), Division of Property Order (DOPO), or other required Order may be necessary to divide some of these assets. The QDRO, DOPO, or other required Order shall be prepared by: ____________________________________ and submitted to the Court within ninety (90) days after the final hearing. Expenses of preparation, approval, and filing shall be paid as follows: The parties acknowledge that failure to file a QDRO, DOPO, or other required Order to effectuate the distribution of an interest in a pension, profit sharing, IRA, 401(k), deferred compensation, or other retirement plan may detrimentally affect the distribution of the retirement interest(s) and may result in further legal proceedings. The Court shall retain jurisdiction to effectuate the intended distribution of retirement interests and to issue, interpret, and enforce the terms of documents of transfer. Supreme Court of Ohio Uniform Domestic Relations Form 19 SEPARATION AGREEMENT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Page  of 14 H. Life Insurance Policies: (select one) 1. Neither party has any interest in any life insurance policy(ies) with a cash value. 2. Plaintiff/Petitioner 1 shall receive the following policy(ies): 3. Defendant/Petitioner 2 shall receive the following policy(ies): 4. Each party shall pay and hold the other harmless from any debt owing on the life insurance policy(ies) he/she receives unless otherwise stated in this Agreement. 5. Other arrangements regarding life insurance policy(ies): If any life insurance policy is not in the name of the party to whom it is distributed, the parties shall transfer the life insurance policy to the proper party no later than thirty (30) days after filing the Final Judgment Entry unless otherwise provided in this Agreement. I. Other Property: (select one) 1. Neither party has any other property. 2. Other property owned by one or both of the parties shall be distributed as follows: Description of Property Party 3. Each party shall pay and hold the other harmless from any debt owing on the property he/she receives unless otherwise stated in this Agreement. Supreme Court of Ohio Uniform Domestic Relations Form 19 SEPARATION AGREEMENT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Page  of 14  4. Other arrangements regarding the property above: If the property listed above is not in the possession or titled in the name of the party to whom it is distributed, the parties shall transfer the property to the proper party no later than thirty (30) days after filing the Final Judgment Entry unless otherwise provided in this Agreement. THIRD: DEBTS (select all that apply) 1. Neither party owes any debt(s) which are not paid in full each month, including, but not limited to, credit cards, medical bills, student loans, tax obligations, and 401(k) or insurance loans. 2. Plaintiff/Petitioner 1 shall pay the following debt(s): Creditor Balance Current Name on Account 3. Defendant/Petitioner 2 shall pay the following debt(s): Creditor Balance Current Name on Account 4. Each party shall pay and hold the other harmless from the above listed debt unless otherwise stated in this Agreement Supreme Court of Ohio Uniform Domestic Relations Form 19 SEPARATION AGREEMENT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Page  of 14  5. Other arrangements regarding debt(s), including refinancing: 6. The Court has continuing jurisdiction to determine whether a debt assigned to a party qualifies as an exception to discharge in bankruptcy. 7. Neither party shall incur liabilities in the name of the other party in the future. FOURTH: SPOUSAL SUPPORT A. No Spousal Support Obligation Neither Plaintiff/Petitioner 1 nor Defendant/Petitioner 2 shall pay spousal support to the other, subject to any jurisdiction reserved in Section E below. B. Spousal Support Obligation Plaintiff/Petitioner 1RU Defendant/Petitioner 2 shall pay spousal support to Plaintiff/Petitioner 1 Defendant/Petitioner2intheamountof $________________ per  month   commencing on __________________________________. Spousal support shall continue for a period of ________________________ months OR until further order of this Court. C. Method of Payment of Spousal Support: Spousal support payments shall be made directly to Plaintiff/Petitioner 1 Defendant/Petitioner 2. (Direct payment can only be made if there are no minor child(ren) and in accordance with R.C. 3121.441.) Spousal support payments, plus two percent (2%) processing charge, shall be made to the Ohio Child Support Payment Central, P. O. Box 182372, Columbus, Ohio 43218-2372, as administered through the _________________________ County Child Support Enforcement Agency by: income withholding or other ___________________________________. D. Termination of Spousal Support Spousal support shall terminate earlier than the above stated date upon Plaintiff/Petitioner 1’s or Defendant/Petitioner 2’s death or in the event of the following: (check all that apply) The cohabitation of the person receiving support in a relationship comparable to marriage. The remarriage of the person receiving support. Other: (specify) E. Reservation of Jurisdiction Under all circumstances, the Court shall retain jurisdiction over the issue of spousal support to hear and determine a Motion for Relief from Judgment pursuant to Civ.R. 60(B). On other matters involving spousal support: (check all that apply) The Court shall retain jurisdiction to establish or modify the amount and/or duration of spousal support in the event either party files bankruptcy. The Court shall NOT retain jurisdiction to establish or modify the amount and/or duration of spousal support in the event either party files bankruptcy. The Court shall retain jurisdiction to modify the amount of the spousal support order. Supreme Court of Ohio Uniform Domestic Relations Form 19 SEPARATION AGREEMENT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Page 1 of 14  The Court shall NOT retain jurisdiction to modify the amount of the spousal support order. The Court shall retain jurisdiction to modify the duration of the spousal support order. The Court shall NOT retain jurisdiction to modify the duration of the spousal support order. F. Other orders regarding spousal support: (specify) G. Arrearage or Overpayment Any temporary spousal support arrearage or overpayment shall survive the Judgment Entry. Any temporary spousal support arrearage or overpayment shall not survive the Judgment Entry. Other: FIFTH: NAME shall be restored to the former name of SIXTH: ALLOCATION OF PARENTAL RIGHTS AND RESPONSIBILITIES, PARENTING TIME, CHILD SUPPORT, AND HEALTH CARE The parties do not have (a) child(ren) subject to the jurisdiction of the Court. The parties have (a) child(ren) subject to the jurisdiction of the Court, and a Parenting Plan is attached Shared Parenting Plan is attached. SEVENTH: OTHER The parties agree to the following additional matters: EIGHTH: NON-USE OF OTHER’S CREDIT Neither party shall incur any debt or obligation upon the credit of the other or in their joint names. If a party incurs such debt or obligation that party shall repay, indemnify, and hold the other harmless as to any such debt or obligation. All joint credit card accounts shall be immediately cancelled. All joint credit cards shall be immediately destroyed. NINTH: INCORPORATION INTO JUDGMENT ENTRY If one or both of the parties institute or have instituted proceedings for dissolution, divorce, or separation, this Agreement shall be presented to the Court with the request that it be adjudicated to be fair, just, and proper, and incorporated into a Judgment Entry. TENTH: PERFORMANCE OF NECESSARY ACTS Upon execution and approval of this Agreement by the Court, each party shall deliver to the other party, or permit the other party to take possession of all items of property to which each is entitled under the terms of this Agreement, and shall make all periodic payments required under the terms of this Agreement. Supreme Court of Ohio Uniform Domestic Relations Form 19 SEPARATION AGREEMENT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Page 1 of 14 ELEVENTH: SEVERABILITY If any provision of this Agreement is held to be invalid or unenforceable, all other provisions shall continue in full force and effect. TWELFTH: APPLICABLE LAW All of the provisions of this Agreement shall be construed and enforced in accordance with the laws of the State of Ohio. THIRTEENTH: MUTUAL RELEASE Except as otherwise provided, the parties release and forever discharge each other from any and all actions, suits, debts, claims, demands, and obligations whatsoever, both in law and in equity, which either of them ever had, now has, or may have or assert against the other upon or by reason of any matter or cause to the date of the execution of this Agreement. Each party waives all rights of inheritance and the right to share in the estate of the other, and waives all rights which would otherwise be available as a surviving spouse, except payments or rights included in this Agreement. Plaintiff/Petitioner 1 Signature Defendant/Petitioner 2 Signature ______________________________________________________ _______________________________________________________ Printed Name Printed Name ______________________________________________________ ______________________________________________________ Date Date ACKNOWLEDGMENT STATE OF OHIO ) ) SS COUNTY OF ___________________ ) Before me, a Notary Public, personally appeared __________________________, Plaintiff/Petitioner 1, who acknowledged that Plaintiff/Petitioner 1 has signed the Separation Agreement, that Plaintiff/Petitioner 1 understands the Separation Agreement, and that Plaintiff/Petitioner 1 is aware of the consequences of signing the Separation Agreement. The foregoing Separation Agreement was acknowledged before me this __________________________ (date) by ___________________________________________ (Plaintiff/Petitioner 1). No oath or affirmation was administered to the signer with regard to this notarial act. ________________________________________________ Signature of Notary Public ________________________________________________ Printed Name of Notary Public Commission Expiration Date: ________________________ (Affix seal here) Supreme Court of Ohio Uniform Domestic Relations Form 19 SEPARATION AGREEMENT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Page 1 of 14  STATE OF OHIO ) ) SS COUNTY OF ___________________ ) Before me, a Notary Public, personally appeared __________________________, Defendant/Petitioner 2, who acknowledged that Defendant/Petitioner 2 has signed the Separation Agreement, that Defendant/Petitioner 2 understands the Separation Agreement, and that Defendant/Petitioner 2 is aware of the consequences of signing the Separation Agreement. The foregoing Separation Agreement was acknowledged before me this __________________________ (date) by ___________________________________________ (Defendant/Petitioner 2). No oath or affirmation was administered to the signer with regard to this notarial act. ________________________________________________ Signature of Notary Public ________________________________________________ Printed Name of Notary Public Commission Expiration Date: ________________________ (Affix seal here) Print Form Supreme Court of Ohio Uniform Domestic Relations Form 19 SEPARATION AGREEMENT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Page 1 of 14