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IN THE COURT OF COMMON PLEAS
Division
COUNTY, OHIO
:
Plaintiff/Petitioner 1
:
Case No.
:
Street Address
:
:
Judge
City, State and Zip Code
:
:
and
:
Magistrate
:
:
Plaintiff/Petitioner 2
:
:
Street Address
:
:
City, State and Zip Code
:
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), child(ren) with disabilities, or you or the Spouse are/is pregnant, a Shared Parenting Plan (Uniform Domestic
Relations Form 17) or Parenting Plan (Uniform Domestic Relations Form 18) must be attached.
SEPARATION AGREEMENT
The parties,
, (name), and
, (Spouse’s name), state the following.
1.
The parties were married to one another on
(date of marriage)
in
(city or county, and state), and request
that the termination of marriage be the date of final hearing or as specified:
2.
The parties intend to live separate and apart.
3.
Each party has made full and complete disclosure to the other of all marital property, separate
property, and any other assets, debts, income, and expenses.
4.
Neither party has knowledge of any other property and debts of any kind in which either party has an
interest.
Supreme Court of Ohio
Uniform Domestic Relations Form 16
SEPARATION AGREEMENT
Approved under Ohio Civil Rule 84
Amended: March 15, 2016
Page 1 of 13
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