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Wife _________ ________ Husband

Settlement Agreement With Children C Rev. July 2012 Page 1 of 11

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IN THE SUPERIOR COURT OF ____________________ COUNTY

STATE OF GEORGIA

,

Plaintiff,

vs.

,

Defendant.

Civil Action

Case Number

SETTLEMENT AGREEMENT WITH MINOR CHILDREN

This is an agreement between

(referred to here as

“Wife”) and

(referred to here as “Husband”) dated

_______________________.

The parties are married but are currently separated; and

They have

minor children together, who are listed below:

Child’s Name

Date of Birth

The parties want to settle between themselves all questions of custody, visitation, child support,

insurance, alimony, division of property, debts and all other rights and obligations arising out of their

marital relationship;

THEREFORE, in consideration of the mutual promises and declarations in this agreement, the

parties agree as follows:

1. SEPARATION

.

The parties shall continue to live apart and each one shall be free from all interference and

control by the other, as fully as if unmarried, and each may reside at such places as he or she may

choose.

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Select a county

Wife _________ ________ Husband

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2. CUSTODY

[Check and complete only one of these, either (a) or (b). Do not check both (a) and (b).]

(If you want a custody arrangement that is not shown here, you should

consult an attorney for appropriate language to use in place of this section.)

(a) The shall have sole custody of the children.

(b) The

shall have physical custody of the children, and the parties

shall have joint legal custody of them. The parties shall consult each other and try to reach a joint

decision on all major issues concerning the children=s education, health care and religious upbringing.

However, if the parties are not able to reach a joint decision concerning one of these major issues, then

the parent with physical custody shall make the final decision on the issue.

3. VISITATION

The shall have the right of reasonable visitation with the minor

children, at any time by mutual consent of the parties, provided that the beginning and ending times of

the visitation have been put into writing and signed by both parties before the start of the visitation. In

arranging visitation, the parties shall take into consideration the requirements of the children’s school,

work, their activities, and child care arrangements.

[Check and complete all that apply, from (a) to (d) of this section.]

(a) If the parties cannot agree on specific visitation, the shall have the right

to visitation according to the Parenting Plan attached hereto.

(b) The visiting parent shall notify the other parent at least 24 hours in advance of any scheduled

visitation if he/she does not intend to exercise that visitation opportunity.

(c) The visiting parent shall arrive to pick up the children for visitation within

minutes of

the scheduled time, or shall lose that visitation opportunity.

(d) Unless otherwise agreed by the parties in writing, the drop-off and pick-up for visitation shall

be at

.

4. OTHER PARENTAL RIGHTS

The parties acknowledge that the children have two parents who love them and want to be

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Wife _________ ________ Husband

Settlement Agreement With Children C Rev. July 2012 Page 3 of 11

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involved in their upbringing. The parties agree that the welfare of the children is most important and

each agrees to encourage a feeling of affection and respect between the children and the other parent.

Neither party shall involve the children in actions or communications, which would endanger the

children’s opinion of the other party.

(a) Addresses and Telephone Numbers

: The parties agree to provide each other with their current

home address and telephone number, as well as a telephone number to call in case of

emergency; they also agree to notify each other of any change in the address or telephone

numbers, at least 30 days prior to the change.

(b) Telephone Communication: Neither party shall do anything to interfere with the children

communicating with the other party. Each party shall have the right to call and talk to the

children when they are in the care of the other party, up to one time each day, at the expense of

the calling parent. Calls shall be made between the hours of a.m. and p.m.

(c) School Information: The parties agree that it is in the best interest of the children that both

parents should participate in the children’s educational activities to the fullest extent possible.

Therefore, both parties shall have equal access to the school records of the children, and both

shall have the right to be provided information concerning the children’s progress in school.

(d) Health Information: Each party shall be entitled to complete, detailed information from any

physician, dentist or other health care provider attending any of the children. Each party shall

notify the other of the children’s major illnesses and medical treatments.

(e) Guests

: Each party agrees that no overnight visitors of the opposite sex, to whom he or

she is not related, will be allowed while the minor child/children is/are in the home.

(f) Use of Alcohol and/or Drugs

: Neither party shall be under the influence of alcohol while

in the presence of the minor child. Neither party shall consume drugs that are not authorized by

a valid prescription.

5. CHILD SUPPORT

(Note: This section must be completely filled out. The Court cannot approve the divorce unless the child

support arrangement is within the guidelines in OCGA § 19-6-15, or a proper reason is explained in this

section for a support amount outside the guidelines.)

The

shall pay the , for the support of the minor

children, the sum of

Dollars

($ ) per month, beginning on , 20 . The child support shall

continue monthly thereafter until each child reaches the age of eighteen, dies, marries, or otherwise

becomes emancipated; except that if a child becomes eighteen years old while enrolled in and

attending secondary school on a full-time basis, then the child support shall continue for the child until

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the child has graduated from secondary school or reaches twenty years of age, whichever occurs first.

Application of Child Support Guidelines. The Child Support Addendum, Child Support

Worksheet and appropriate schedules have been attached and are hereby made a part of this order.

6. INCOME DEDUCTION ORDER

[Check and complete only one of these, either (a) or (b). Do not check both.]

(a) An Income Deduction Order shall be entered by the Court, under OCGA § 19-6-32, for

payment of the child support and alimony (if any) provided in this Agreement. The Income Deduction

Order shall take effect:

[To finish (a), you must check and complete either (1) or (2). Do not check both.]

(1) immediately upon entry by the Court.

(2) upon accrual of a delinquency equal to one month’s support and may be enforced by

serving a A Notice of Delinquency, as provided in OCGA § 19-6-32 (f).

(b) The parties agree that an Income Deduction Order is not immediately necessary.

7. HEALTH INSURANCE FOR CHILDREN

[You must check and complete either (a) or (b); but do not check both (a) and (b).

(c) is optional, and may be combined with either (a) or (b).]

(a) The (Plaintiff or Defendant) shall maintain a policy of medical,

dental and hospitalization insurance for the benefit of the minor children, until each child reaches the

age of eighteen, dies, marries, or otherwise becomes emancipated; except that if a child becomes

eighteen years old while enrolled in and attending secondary school on a full-time basis, then the

insurance shall continue for the child until the child has graduated from secondary school or reaches

twenty years of age, whichever occurs first.

(1) The parent who maintains the insurance shall provide the other parent with an insurance

identification card or such other acceptable proof of insurance coverage and shall cooperate

with the other parent in submitting claims under the policy.

(2) All money received by one of the parties for claims processed under the insurance policy

shall be paid to the other party (if that other party paid the applicable health care service

provider) or to the applicable health care provider within five (5) days of the party receiving the

money, if the provider has not been paid by one of the parties.

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(b) Insurance is not available to either party at a reasonable cost. If health insurance for the

children later becomes available to the parent who is required to pay child support under this

Settlement Agreement, then that parent must obtain the insurance unless it is then being provided by

the other parent. When insurance has been obtained by either party, Paragraphs 7 (a)(1) and (2) shall

apply.

(c) The parent who maintains the insurance shall provide verification of the amount paid for the

children’s share of the cost of medical, dental and hospitalization insurance. The other parent shall

reimburse the parent who maintains the insurance for %

of the cost within fifteen (15) days

after receiving the verification.

8. OTHER HEALTH CARE EXPENSES FOR THE CHILDREN

[Check and complete either (a), (b) or (c); or both (a) and (b) together.

Do not check (c) if you check either (a) or (b).]

(a) The (Plaintiff or Defendant) shall be responsible for all expenses

incurred for the children’s health care (including medical, dental, mental health and hospital care) that

are not covered by insurance. The other parent shall provide verification to the (Plaintiff or Defendant)

of amounts paid or incurred for the children’s health care. The (Plaintiff or

Defendant)

shall reimburse the other parent or pay the health care

provider directly within fifteen (15) days after receiving the verification of a particular health care

expense.

(b) The (Plaintiff or Defendant) shall pay % and the

(Plaintiff or Defendant)

shall pay % of all expenses incurred for the

children’s health care (including medical, dental, mental health and hospital care) that are not covered

by insurance. The party who incurs a health care expense for one of the children shall provide

verification of the amount to the other party. That other party shall reimburse the incurring party (or

pay the health care provider directly) for the appropriate percentage of the expense, within fifteen (15)

days after receiving the verification of a particular health care expense.

9. LIFE INSURANCE FOR THE BENEFIT OF THE CHILDREN

[Check and complete either (a), (b) or (c). Do not check more than one.]

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Wife _________ ________ Husband

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(a) The children depend on the (Plaintiff or Defendant)

for financial

support, and therefore the (Plaintiff or Defendant)

agrees to maintain a

policy of insurance on his/her life, with a face amount of at least $

, for the benefit of

the minor children. The policy shall be maintained for so long as at least one of the children is a minor

or is otherwise entitled to support under Paragraph Five of this Agreement.

(b) The children depend on both of the parties for financial support, and therefore each party agrees

to maintain a policy of insurance on his/her life, with a face amount of at least $

, for

the benefit of the minor children. The policy shall be maintained for so long as at least one of the

children is a minor or is otherwise entitled to support under Paragraph Five of this Agreement.

(c) The parties are not asking the Court to address the issue of life insurance for the benefit of the

children in this action.

10. ALIMONY

.

[Check and complete only one of these, either (a) or (b). Do not check both (a) and (b).]

(a) The (Plaintiff or Defendant) shall pay to the (Plaintiff or Defendant)

as alimony, the sum of Dollars

($

) per month, beginning on , and continuing monthly thereafter,

[To finish (a), you must check and complete either (1) or (2). Do not check both (1) and (2)]

(1) until the recipient remarries or dies.

(2) for a period of .

(b) Each party expressly waives the right to receive alimony from the other party.

11. PROPERTY DIVISION.

[Check and complete only one of these, either (a), (b) or (c). Do not check both (a), (b) and (c)]

(a) The parties acknowledge that they have already made a division of their marital property,

including any real estate, vehicles, household furniture, furnishings, household goods, equipment, bank

accounts, pensions and other personal property. Neither party shall claim any of the property in the

possession of the other party as of the date of signing this agreement.

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Wife _________ ________ Husband

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(b) The parties acknowledge that they did not obtain any property during their marriage.

(c) The parties acknowledge that they possess various items of marital property, which shall be

divided as provided in this Agreement. The parties agree to transfer possession and title to their

property as follows:

[If you have chosen (c), check and complete only the parts that apply, from (1) through (4) below

. Cross out

the parts that do not apply.]

(1) Marital Home - The marital home of the parties, located at the following address:

, which has the following

legal description on the deed to the property:

shall be conveyed to the (Plaintiff or Defendant)

in fee simple. The

(Plaintiff or Defendant)

shall be responsible for all taxes, assessments and

mortgage loan payments on the home after the date of .

[If you have chosen and completed the preceding paragraph (1), concerning a marital home, you may

also check and complete (A) or (B), or both (A) and (B), but neither one is required.]

(A) The (Plaintiff or Defendant) shall have a lien against

the home in the amount of

Dollars

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Wife _________ ________ Husband

Settlement Agreement With Children C Rev. July 2012 Page 8 of 11

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($ ). Upon the sale or transfer of the home, the lien shall be paid.

(B) The (Plaintiff or Defendant) shall immediately begin

making reasonable efforts to refinance the outstanding mortgage/mortgages on

the marital home, so that the (Plaintiff or Defendant)

shall

no longer be liable on the mortgage loan(s). If the (Plaintiff or Defendant)

is not able to refinance by , 20 ,

the home shall then be listed for sale at a reasonable price, and all reasonable

offers to purchase the home shall be accepted.

(2) Mobile Home - The parties= mobile home, which is described as a

, with Vehicle Identification Number (VIN)

of

shall be transferred to the (Plaintiff or Defendant)

. The (Plaintiff or Defendant) shall be

responsible for all loan payments on the mobile home after the date of

.

(3) Vehicles - The vehicles owned by the parties shall be transferred or retained as follows:

Year/Make/Model of Vehicle

Vehicle ID # (VIN) Goes to

The party listed above for each vehicle shall be responsible for all car loan payments, ad

valorem taxes, registration fees and insurance on that vehicle accruing after the following date:

.

(4) Other Personal Property - The parties acknowledge that they own various other items

of personal property, which shall be transferred to the party listed below, on or before

, 20 .

To the Wife

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To the Husband

Except as otherwise specifically provided in this Agreement, the transfers listed above

shall be completed no later than

, and each party shall execute all

documents necessary to promptly complete the transfer. Upon the failure of either party to

execute and deliver any deed or other document necessary to complete the transfers required by

this Agreement, this Agreement shall constitute and operate as the properly executed document.

The county auditor, county recorder, Department of Motor Vehicles, and all other public and

private officials are authorized and directed to accept this Agreement or a properly certified

copy of it in lieu of the document regularly required for the conveyance or transfer.

Except as provided in this Agreement, the parties have divided their marital property,

including any real estate, vehicles, household furniture, furnishings, household goods,

equipment, bank accounts, pensions and other personal property. Neither party shall claim any

of the property in the possession of the other party as of the date of signing this agreement,

except as provided in this Agreement.

12. DEBTS

.

[Check and complete only one of these, either (a) or (b). Do not check both (a) and (b)]

(a) The parties acknowledge that they have no outstanding joint or marital debts.

(b) The responsibility for payment of the parties’ joint and marital debts shall be as follows:

Creditor

Amount Responsible Party

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Wife _________ ________ Husband

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The responsible party listed above for each debt shall hold the other party harmless for any

collections on that debt. If legal action is brought against the other party to recover that debt, the

responsible party agrees to indemnify or hold the other party harmless and, in addition, to pay all

attorney=s fees and costs of collection which the other party may incur as a result of the legal action.

13. TAX AND BANKRUPTCY CONSTRUCTION OF THIS AGREEMENT

The parties acknowledge that the equitable division of marital property and the payment of

marital and joint debts, if provided in this Agreement, shall not be deductible nor taxable for income

tax purposes. Each party also acknowledges that, but for the payments provided here, the other party’s

financial independence would be impaired. Therefore, it is the parties’ intention that if either party

ever seeks bankruptcy protection, the amounts payable under this Agreement shall not be

dischargeable in bankruptcy under 11 United States Code Section 523(a)(5), as the payments are in the

nature of spousal or child support and maintenance. Alternatively, the payments shall be

nondischargeable in bankruptcy under 11 United States Code Section 523(a)(15).

14. RESTRAINING ORDER

(Optional: Check and complete this paragraph if applicable.)

The (Plaintiff or Defendant) shall be permanently restrained and

enjoined from assaulting, beating, wounding, threatening, harassing and stalking the (Plaintiff or

Defendant)

. By consenting to this, the (Plaintiff or Defendant)

in no way admits that such acts were ever done in the past, but agrees not to

engage in such acts in the future. This provision shall be enforceable by the Court=s contempt power.

15. RESTORE FORMER OR MAIDEN NAME

:

[Check only if applicable.]

My former or maiden name is ,

and I am asking the Court to restore that name to me.

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Wife

________Husband

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16. VOLUNTARINESS OF AGREEMENT

The parties acknowledge that they have entered into this Agreement freely and voluntarily, and

that it is not the result of any duress or any undue influence. We understand that we do not have to

enter into this Agreement, that we have the right to trial before a judge or jury on all issues that could

be raised in this action. We also understand that we have the right to certain discovery procedures that

may reveal other income or assets of the other party. We have agreed to enter into this Agreement

based on our knowledge of the income and assets of the parties and their written statements in this

Agreement. After considering all of this, we have decided to enter into this Agreement freely and

voluntarily.

17. COMPLETENESS OF AGREEMENT

This Agreement constitutes the entire understanding of the parties. There are no

representations or promises other than those expressly included in this Agreement. Each party hereby

states under oath that the financial representations in this Agreement are accurate and complete, to the

best of that party ’s information, knowledge and belief.

18. EFFECT OF DIVORCE

Both parties understand that this Agreement does not require them to continue to live separately

or to proceed with an action for divorce. However, if either party brings or maintains an action for

divorce, this Agreement shall be presented to the court and incorporated by reference into any

judgment concerning the matters covered by the Agreement. Even if it becomes part of a divorce

judgment, this Agreement shall survive and can be enforced independently from the judgment of

divorce.

Wife

Sworn to and subscribed before me this _____

day __________________________, 20_____.

Notary Public

My Commission Expires: _____________

Husband

Sworn to and subscribed before me this _____

day __________________________, 20_____.

Notary Public

My Commission Expires: _____________

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