RECONCILIATION PENDING ABSTINENCE
_________________________________ (Husband or Wife) agrees to return to the home and resume all marital relations based on the condition that the spouse refrains from all use of alcohol and illegal drugs. ________________ (He/She) agrees to live in the home with the spouse as long as _________ (He/She) agrees to these conditions.
________________________________ Signature of Wife
_____________________ Date
________________________________ Signature of Husband
_____________________ Date
_______________________________ Signature of Witness
_____________________ Date