AGREEMENT made by and between ______________ of __________, __________
County, Massachusetts (the "Husband") and _______________ of ____________, __________
County, Massachusetts (the "Wife"), referred to in this Agreement individually as a "Party" or
together as the “Parties," as of the date both Parties have signed the Agreement.
STATEMENT OF FACTS
The Parties were married on ______________, in ____________, and last lived
together at ________________ in _______________, Massachusetts on or about __________,
20__. This is the ________ marriage for the Husband and the __________ marriage for the
There are __________ unemancipated children born of the marriage whose names and
dates of birth are: ____________ (date of birth _____________) and ____________ (date of
birth ___________) (collectively, the “Children”).
The Parties are living separate and apart. Serious and irreconcilable differences have
arisen between the Parties, and the Parties acknowledge there is