Prenuptial Agreement 193140044

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                                 Prenuptial Agreement

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                                 PARTY INFORMATION
                                   Future Husband
Full Name


Address



City                                    State                         Postal/ZIP Code


                                       Future Wife
Full Name


Address



City                                    State                         Postal/ZIP Code


                                       PROPERTY
List each party’s present property?

              ☐ Yes                    ☐ No
List of Each party’s Present Property/Properties:
Separate Property:
            ☐ All property unless there is proof of shared legal ownership
             ☐ Certain types of property may be treated as separate
             ☐ In the event of separation property will not be influenced by this
               agreement


Properties treated as separate:
              ☐ Property owned by a party at the date of execution of this agreement
             ☐ Property acquired by a party after the date of execution of this
                agreement
             ☐ Property acquired in exchange for present property, or from the
                proceeds of a sale of present property
             ☐ Income or proceeds derived from property owned by a party before or
                after the execution of this agreement
             ☐ Property acquired by either party with income received during their
                cohabitation from property owned by a party before or after the
                execution of this agreement
            ☐ The increase in value during the period of cohabitation of any property
                owned by a party before or after the execution of this agreement
             ☐ Gifts from the other party
             ☐ Property acquired through an inheritance
             ☐ Winnings from any sport, game or lottery
             ☐ Any award or settlement from a lawsuit
             ☐ The proceeds of any insurance policy
             ☐ Individual earnings, salary or wage, acquired before or after the
                execution of this agreement
             ☐ Individual savings (held in sole bank accounts) acquired before or after
                the execution of this agreement
List shared property?
                        ☐ Yes                     ☐ No
List shared property:




Assessment of shared property in the event of separation:
             ☐ Each party will own 50% of the property
             ☐ Based on financial contribution of each party
             ☐ Other:
Transfers from one party to another to be evidenced in writing:
             ☐ Yes                                ☐ No
                                         DEBTS
List debts jointly incurred?
                        ☐ Yes                     ☐ No
List of debts owned in common:




Separate Debts:
            ☐ All debts unless there is proof of shared legal ownership
             ☐ Certain debts may be treated as separate
             ☐ In the event of separation debt obligations will not be influenced by this
                 agreement

Types of debt that are considered separate:
             ☐ Debts owing by one party at the date of execution of this agreement
             ☐ Debts incurred by one party after the date of execution of this
                 agreement
             ☐ Other:

List of separate debts?
                          ☐ Yes                   ☐ No
List of separate debts:




Assessment of debts in the event of separation:

              ☐ Each party will be responsible for 50% of the debt
              ☐ Based on financial contribution of each party
              ☐ Other:
                                        CHILDREN
Are there children from previous relationship
              ☐ Yes                 ☐ None

Names and Ages of Children of Future Husband:




Names and Ages of Children of Future Wife:




Children borne from this relationship
              ☐ Yes                 ☐ None

Names and Ages of Children
Is the other party entitled to support in the event of separation?
              ☐ Each party agrees there will be no support
              ☐ Yes, as determined by law
             ☐ One party will be entitled to support
                       ☐ Husband             ☐ Wife
                                  ☐ Lump sum payment
                                  ☐ Monthly payment
                                  ☐ Property
                                  ☐ Other:
              ☐ Other:

Right to other party’s estate:
              ☐ Do not specify
              ☐ No
             ☐ Yes, as long as the parties are together
                       ☐ Death or survivor benefits
                       ☐ Other:

                                  ADDITIONAL CLAUSE(S)




State where future husband will sign:        State where future wife will sign:




Executed in front of Notary Public?          Certificate of Independent Advice?
       ☐ Yes       ☐ No                             ☐ Yes       ☐ No
               YOUR NAME AND DATE
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posted:10/1/2012
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