_________________ [typed name]
On ____________________ [date], before me, _________________[name], a Notary Public
in and for the State [Commonwealth] of _________________, County of ___________________,
personally appeared _________________[names of First and Second Parties], who proved
to me on the basis of satisfactory evidence to be the persons whose names are
subscribed to this instrument, and acknowledged that they executed this instrument
in their authorized capacities, and that by their signatures on the instrument the
persons executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State
[Commonwealth] of _________________ that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
ALTERNATIVE PROVISIONS REGARDING RESPONSIBILITY
FOR JOINT LIVING EXPENSES:
1. Living Expenses
(a) _________________[Name of first party] currently earns approximately $_____ per year
from _____ [his or her] employment. _________________[Name of second party] currently
earns approximately $_____ per year from _____ [his or her] employment. Based on
their total monthly income of $_____, the parties shall share their living expenses on a
pro rata basis. _________________[Name of first party] shall contribute _____ percent to
payment of the parties' monthly living expenses, and ________________ [name of second