Full Name of the First Party Full Name of the Second Party Signed in the presence of: Signature of Witness Name of Witness Address of Witness Signature of Witness Name of Witness Address of Witness NOTARY ACKNOWLEDGEMENT: State of ) ) (Seal) County of ) The foregoing instrument was acknowledged before me this day of , 20, by the undersigned, , who is personally known to me or satisfactorily proven to me to be the person whose name is subscribed to the within instrument.. Signature Notary Public My Commission Expires: CERTIFICATE OF INDEPENDENT LEGAL ADVICE THE STATE OF COUNTY OF I, , of the City of , in the State of , Attorney, DO HEREBY CERTIFY: THAT I was this day consulted in my professional capacity by , named in the within instrument, being a Cohabitation Agreement, separate and apart from , as to their legal rights and liabilities under the terms and conditions of it, and that I acted solely for him or her, and explained fully to him or her the nature and effect of the said Cohabitation Agreement and they did execute it in my presence, and did acknowledge and declare that they were executing it of her own volition and without any fear, threats, compulsion or influence from , or any other person.. ATTORNEY Printed Name CERTIFICATE OF INDEPENDENT LEG
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