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ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number and address):

FOR COURT USE ONLY

Jane Garcia-Smith 123 Main Street Sacramento, California, 98765 123-456-7890 _________________ __________________________________________________________________________ SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO STREET ADDRESS: ________________________________ MAILING ADDRESS: ________________________________ CITY AND ZIP CODE: ________________________________ BRANCH NAME: ________________________________ MARRIAGE OF HUSBAND: WIFE: John Smith Jane Garcia-Smith CASE NUMBER: LEGAL SEPARATION AGREEMENT Jane Garcia-Smith of 123 Main Street, Sacramento, California 98765, born April 11, 1973, and John Smith of 123 Main Street, Sacramento, California 98765, born August 12, 1974, being sworn do hereby state the following statements are true and correct and that except as otherwise specifically stated in this Agreement, this Agreement serves as a full and final settlement of all matters of joint concern for the parties, including all property rights, debts, spousal support, child custody, visitation, and child support. The parties agree this Agreement contains a fair, just and equitable division of property and debts and is satisfactory to both parties. 1. JURISDICTION. Jane Garcia-Smith and John Smith acknowledge they have both resided in Sacramento county for 10 years and 3 months which satisfies the residency requirements of the State of California. ARMED FORCES. Neither party is a member of the Armed Forces. MARRIAGE DATE. The parties were married to each other on June 15, 2002 in Napa, California and 1 child was born to this marriage. The only remaining minor child is a daughter, Samantha Garcia-Smith, whose date of birth is August 29, 2007.

2. 3.

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The parties are not currently expecting any children. 4. 5. SEPARATION DATE. The parties are not currently separated. CAUSE OF DISSOLUTION. Due to irreconcilable differences the marriage of the parties has been irretrievably broken and there is no possibility of reconciliation. DISCLOSURE. The parties acknowledge that each has made a full disclosure of all assets and debts owned jointly or individually. Whether community or separate property, nothing has been withheld and each party believes the other has been truthful in their disclosure.

6.

Each party hereby waives the requirements of Family Code section 2105 (a) that requires the parties to serve on each other final declarations of disclosure and income and expense declaration. Pursuant to Family Code section 2105 (d), the parties declare as follows: (a) Both parties have complied with Section 2104 and the preliminary declarations of disclosure have been completed and exchanged. (b) Both parties have completed and exchanged a current income and expense declaration, which includes all material facts and information regarding that party's earnings, accumulations, and expenses. (c) Both parties have fully complied with Section 2102 and have fully augmented the preliminary declarations of disclosure, including disclosure of all material facts and information regarding the characterization of all assets and liabilities, the valuation of all assets that are contended to be community property or in which it is contended the community has an interest, and the amounts of all obligations that are contended to be community obligations or for which it is contended the community has liability. (d) The waiver is knowingly, intelligently, and voluntarily entered into by each of the parties. (e) Each party understands that this waiver does not limit the legal disclosure obligations of the parties, but rather is a statement under penalty of perjury that those obligations have been fulfilled. Each party further understands that noncompliance with those obligations will result in the court setting aside the judgment. 7. INCOME. Jane Garcia-Smith has a total gross monthly income of $5,500.00 which includes income from the following sources:

Salary
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School Teacher $5,500.00 per month. John Smith has a total gross monthly income of $6,200.00 which includes income from the following sources: Salary IT Technician $6,200.00 per month. 8. CHILD CUSTODY & VISITATION. a. Legal Custody. Legal custody for the purpose of this agreement refers to the authority to make major decisions regarding minor child of the marriage, which can include but is not limited to health care, religion, and education. The parties agree to maintain joint legal custody of their minor child. Physical Custody. Physical custody for the purpose of this agreement refers to the authority to make routine and day-to-day decisions regarding the child and where the child's primary residence will be. The parties agree Jane Garcia-Smith will have sole physical custody of the parties' minor child. Parenting Time/Visitation. The non-custodial parent will have visitation with the minor children as follows: i. ii. Every other weekend starting Friday at 5:00 p.m. and ending on Sunday at 7:00 p.m. Every Wednesday from 5:00 p.m. until the minor child is delivered to school or daycare the following morning.

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Holiday/Extended Visitation. The parents believe they can work together to establish a holiday visitation schedule. Transportation. The parties agree to equally divide the cost of transportation for all visitation. Notification. The parties agree that neither party will change the residence of the minor child of the parties without adequate prior written notification. The parties further agree that this visitation and custody agreement will be reassessed if either party relocates and the new residence makes the current agreement unfeasible to manage. The parties agree to provide one another with their current phone number and physical address. Childcare. The parties agree to allow one another the first opportunity to
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e.

f.

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have the children if he or she is unable to care for the children during their scheduled time. The parties agree to work together to make decisions regarding childcare providers. h. Health Insurance. The parties agree John Smith will be responsible for paying the health insurance for the minor child so long as it is available at no or nominal cost through their employment. Non-Covered Medical. The parties agree that each party shall be responsible for 50% of any non-covered or co-pay expenses related to medical, dental, optometric, orthodontic, physical therapy, psychiatric or pharmaceutical needs of the minor children. A parent shall provide the other with a statement documenting any payments made and the other parent shall reimburse the paying parent within 30 days of receipt of this statement. Taxes Related to Children. The parties agree the parent who has physical custody shall be entitled to claim the minor children for tax purposes in this year and every year thereafter. Parental Rights and Responsibilities. Each parent has the following rights and responsibilities unless they relinquish their parental rights: i. ii. Right to access and obtain copies of the child's educational, medical, dental, religious, insurance, and other records or information. Right to attend educational conferences concerning the child. This right does not require any school to hold a separate conference with each parent. Right to reasonable access to the child by written, telephonic, and electronic means. Duty to inform the other parent as soon as reasonably possible of a serious accident or serious illness for which the child receives health care treatment. The parent shall provide to the other parent a description of the serious accident or serious illness, the time of the serious accident or serious illness, and the name and location of the treating health care provider. Duty to immediately inform the other parent of residential telephone numbers and address, and any changes to the same. Duty to keep the other parent informed of the name and address of the school the child attends.

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The court shall include, in an order establishing or modifying parental rights and responsibilities' the rights and duties listed in this section; however, the court may restrict or exclude any right or duty listed in this section if the order states the reason in support of the restriction or exclusion. The court shall consider any domestic violence protection orders regarding the parties when determining
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whether to restrict or exclude any right or duty listed in this section. 9. CHILD SUPPORT. The parties have agreed to child support in the amount of $800.00 per month which is based on agreement between the parties.

Child support payments will commence the 1st day of the month following the entry of the decree. Child Support payment must be paid by the 1st day of the month directly to the custodial parent. 10. COOPERATION AGREEMENT. The parties agree to cooperate with one another in signing any papers or legal documents needed to finalize this agreement or any provision contained in this agreement, including deeds, title certificates, etc. Within 10 days of notification of Entry of Judgment, the parties shall execute any document, transfer papers, titles or other documents to effect the provisions of this Agreement and any resulting Decree of Legal Separation. In the event a party fails to sign transfer documents, the final Decree of Legal Separation shall operate to transfer title. DIVISION OF ASSETS. Each party shall receive any and all, tangible and intangible, property in his/her possession unless stated otherwise in this agreement. a. Marital Home. The parties agree Jane Garcia-Smith will remain in the home located at 123 Main Street, Sacramento, California 98765 and have sole rights to occupy the home during the legal seperation. John Smith will continue to be bound for all mortgages on the property during this legal seperation. The parties agree to share expenses related to the marital home during the legal seperation as follows: John Smith agrees to pay two-thirds of the mortgage payment during the legal separation. Jane Garcia-Smith will be responsible for all other expenses including the remaining portion of the mortgage payment.

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The parties further agree Jane Garcia-Smith will retain the home located at 123 Main Street, Sacramento, California 98765 and have sole and absolute ownership of the same in the event this legal seperation is converted to a divorce. John Smith will continue to be bound for all mortgages on the property should this legal seperation be converted to a divorce. b. Financial Accounts. Jane Garcia-Smith and John Smith own and agree to divide their financial accounts and investments as follows:

Account Name/Number: Checking Account ending in 7890 Financial Institution: Bank of America Current Account Owner: John Smith and Jane Garcia-Smith Husband Receives: 50% Wife Receives: 50%

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c.

Vehicles. Jane Garcia-Smith and John Smith own and agree to divide ownership of their vehicles as follows:

Make: Dodge Model: Durango Year: 2005 Color: Black VIN Number: J125437896 Owner During Separation and Divorce: John Smith Make: Honda Model: Civic Year: 2008 Color: Silver VIN Number: J845721697 Owner During Separation and Divorce: Each spouse agrees to cooperate in signing or exchanging any documents necessary to remove their name from the title to any vehicle he or she does not receive. 12. DEBTS. Each spouse will be responsible for any indebtedness incurred in his or her individual name prior to the date of marriage unless otherwise specifically stated in this agreement. Each spouse will be responsible for any indebtedness incurred in his or her individual name subsequent to the date of separation, unless otherwise specifically stated in this agreement. Each spouse will be responsible for any indebtedness incurred in his or her individual name during the course of the marriage unless otherwise specifically stated in this agreement. a. Mortgages. Jane Garcia-Smith and John Smith agree to divide responsibility for payment of their mortgages as follows:

Mortgage Lender: Bank of America Collateral: $50000.00 Total Amount of Debt: $332,000.00 Husband's Responsibility: 75% Wife's Responsibility: 25% For any mortgage listed above, the responsible party agrees to take all steps necessary to refinance the debt to remove the other spouse's name from the obligation. Both parties will remain on any mortgage they are jointly responsible for as indicated in this agreement. b. Charge/Credit Card. Jane Garcia-Smith and John Smith agree to divide their charge accounts and credit card indebtedness as follows:

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Credit Card Name: Visa card ending in 0716 Total Amount of Debt: $6,000.00 Husband's Responsibility: $3000.00 Wife's Responsibility: $3000.00 The parties agree to take all possible steps to remove the other spouse's name from any of the above debts he or she has assumed sole responsibility over. c. Auto Loans. Jane Garcia-Smith and John Smith agree to divide their current auto loans as follows:

Lender's Name: Wells Fargo Dealer Services Total Amount of Debt: $7,500.00 Husband's Responsibility: 100% Wife's Responsibility: 0% For any auto loan listed above, the responsible party agrees to take all steps necessary to refinance the loan to remove the other spouse's name from the obligation. Both parties will remain obligated on any loan they are jointly responsible for as indicated in this agreement. 13. SPOUSAL SUPPORT/ALIMONY. The parties agree that neither shall receive spousal support from the other and each waives and releases any and all claim against the other for spousal support, maintenance or alimony. The parties further agree the Court will not retain jurisdiction of the matter of spousal support, maintenance or alimony and this waiver, once incorporated in a final decree of divorce, terminates any and all rights each party may have held to such support. MEDICAL INSURANCE. The parties agree John Smith will continue to provide health and medical benefits, including dental, for their spouse after the legal separation is granted until such time as a divorce is final. NAME CHANGE. Jane Garcia-Smith will have the authority to change her name to Jane Garcia should she so desire. TAXES. The parties are not aware of any outstanding tax issues at this time. FUTURE DISPUTE SETTLEMENT. The parties agree that if any dispute, question, disagreement, or change occurs affecting the terms of this Agreement, they will work together to negotiate with each other in good faith, in consideration of their mutual interest, with the purpose of reaching a solution, which is beneficial for the parties. In the event negotiations fail, the parties agree to first seek mediation, through a qualified mediator selected jointly by the parties. Either party may terminate mediation at any time. In the event the dispute is not resolved, either party may motion the Court governing this Agreement and the resulting Decree of Legal Separation or judgment for a decision regarding the disputed matter.
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FULL DISCLOSURE OF ASSETS AND LIABILITIES. The parties hereby represent that they have each made full disclosure to the other party of their individual assets. Each represents that he or she has provided the other with a current financial statement in the proper form pursuant to Rule 401 of the Supplemental Probate Court Rules, which discloses fully and completely all of his or her income, assets, expenses and liabilities. By executing this Agreement, the parties represent that the terms and provisions of this Agreement are fair, just and reasonable and are not the product of fraud, coercion or undue influence and that each signs this Agreement freely and voluntarily. SUBMISSION OF AGREEMENT TO COURT. The parties each agree that this Separation Agreement shall be submitted to the Court for a judge's approval of the terms and entry of Judgment of Legal Separation.

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We request the Court order a permanent legal separation and a final disposition regarding all matters contained in this agreement. In addition, should the parties decide to proceed with a Petition for Divorce or Dissolution of Marriage, the parties ask that this agreement be recognized and incorporated into any final decree issued in that regard. We agree and declare that we have entered into this agreement freely and voluntarily. We believe that this agreement contains a fair and reasonable division of all of the issues related to our marriage. We ask the Court approve this agreement and incorporate all of the terms and conditions into a Final Order and Decree of Legal Separation.

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By executing this agreement I swear that to my knowledge the information contained herein is a full and complete disclosure and it is my intention that this Agreement is a full and final division of the property and debts involved in this marriage and that I am satisfied with the agreement contained herein. Dated: __________________ ____________________________________________ Jane Garcia-Smith 123 Main Street Sacramento, California, 98765 123-456-7890 _________________

STATE OF CALIFORNIA COUNTY OF SACRAMENTO On ____________________ before me, ________________________________, personally appeared Jane Garcia-Smith, proved to me on the basis of satisfactory evidence to be the person (s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal.

________________________________________ (Notary Seal) Signature of Notary Public

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By executing this agreement I swear that to my knowledge the information contained herein is a full and complete disclosure and it is my intention that this agreement is a full and final division of the property and debts involved in this marriage and that I am satisfied with the agreement contained herein. Dated: __________________ ____________________________________________ John Smith 123 Main Street Sacramento, California, 98765 123-987-6543 _________________

STATE OF CALIFORNIA COUNTY OF SACRAMENTO On ____________________ before me, ________________________________, personally appeared John Smith, proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal.

________________________________________ (Notary Seal) Signature of Notary Public

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Filing for a Legal Separation A legal separation can be the first step towards a couple's decision to divorce. In a legal separation, the spouses live separate and apart from one another in an effort to either resolve their marital issues or come to a final determination on how their property will be divided if they proceed to get a divorce. States vary on how they treat spouses who are legally separated and what rights are associated with a legal separation versus a full divorce. The most significant issue is the right to remarry, which is not available to couples who are not divorced. Reasons for Filing for Legal Separation -The couple is not emotionally ready to proceed with a divorce. -The couple can no longer live together, but do not believe in divorce. -The couple resides in a state that requires a separation period prior to divorce. -The couple wants to finalize the separation of property, other assets and debts before beginning the divorce proceedings. It is important to understand that a legal separation action is not necessarily cheaper or faster than a divorce. It could actually be more expensive than a divorce as the party will have to repeat the entire process of filing an action for divorce if they decide to proceed with a divorce. If the spouses know they will ultimately divorce, it may be beneficial to proceed with a divorce directly. For additional help, information and forms you should visit Rocket Lawyer's Divorce Legal Center at http://www.rocketlawyer.com/divorce/divorce-legal-center.aspx How to file for Legal Separation In general, a legal separation action follows the same path and process as a divorce. Every state has its own procedures and requirements for legal separation. In many states, you do not need to prove fault when filing for a legal separation. Instead you may need to assert there are irreconcilable differences that prevent the couple from living together as husband and wife. To start an action for legal separation, one spouse, called the Petitioner or the Plaintiff, must file a Petition for Legal Separation, Summons or Complaint. These documents start the action and inform the Court of basic facts about the couple and why they desire to divorce. Once the documents are filed, the Petitioner will serve the Respondent (the other spouse) with a copy of the papers. At this point, some states require a Financial Affidavit or other form of disclosure regarding the spouses' assets and debts. In addition, if children are involved, the Court may require the parents to complete a Parenting Plan or an education course. If the spouses agree how to divide their property, other assets and debts, they should prepare and submit their Marriage Separation Agreement to the court. After reviewing the Agreement, the Court will issue a Decree of Legal Separation or Limited Divorce as long as the Agreement is found to be fair and equitable by the Court.

Residency and Separation Requirements In order to file for a legal separation, most states have a residency requirement that must be met before the action will be granted. Residency refers to the length of time you have resided in the
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state and county where you are filing for divorce. You will need to check with your County Clerk's office to see if you meet the residency requirement for filing for legal separation. While you are filing for a formal legal separation, the Court may still require that the couple have been separated for a set period of time prior to granting the legal separation. Many states do not have this requirement, but you should check with your local Clerk's office to make certain. Forms If the spouses have reached an Agreement they can use Rocket Lawyer's easy interview process to complete a Marriage Separation Agreement. The Marriage Separation Agreement allows one to divide property, assets, debts and liabilities as well as settle matters of child support, custody and visitation without asking for a final divorce. Additional Assistance The information contained in this article and help sections provided on RocketLawyer.com should not be construed as legal advice or used in lieu of seeking legal advice. If you have legal questions regarding the legal separation process or filing for legal separation, use Rocket Lawyer's Find A Lawyer search engine at http://www.rocketlawyer.com/attorney-directory.aspx to find an attorney in your area.

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