Uniform Domestic Relations Form – 16
S E P ARAT I O N AG R E E M E N T
Approved under Ohio Civil Rule 84
Effecti ve Date: 7/1/2013
IN THE CO URT OF COM MON PLEAS
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 disabili ties, or the Wife is pregnant, a Shared Parenting Plan (Uniform Domestic Relations
Form 17) or Parenting Plan (Uniform Domestic Relations Form 18) mus t be attached.
SEP AR ATI ON AGRE E ME NT
, Wife, state the following.
The parties were married to one another on
(city or county, and state), and request
that the termination of marriage be the date of f inal hear ing or as specified:
The parties intend to live separate and apart.
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.
Neither party has knowledge of any other property and debts of any kind in which either party has an