
IN THE COURT OF COMMON PLEAS 
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Instructions:  This form is used to present an agreement to the Court regarding spousal support, the division of 
personal property, real estate, and debts resulting from the termination of marriage.  If the parties have any minor 
child(ren), child(ren) with disabilities, or you or the Spouse are/is pregnant, a Shared Parenting Plan (Uniform Domestic 
Relations Form 17) or Parenting Plan (Uniform Domestic Relations Form 18) must be attached. 
, (Spouse’s name), state the following. 
The parties were married to one another on  
(city or county, and state), and request 
that the termination of marriage be the date   of final hearing or   as specified:  
The parties intend to live separate and apart. 
Each party has made full and complete disclosure to the other of all marital property, separate  
property, and any other assets, debts, income, and expenses. 
Neither party has knowledge of any other property and debts of any kind in which either party has an  
 
Supreme Court of Ohio 
Uniform Domestic Relations Form – 16     
SEPARATION AGREEMENT   
Approved under Ohio Civil Rule 84 
Amended: March 15, 2016
 
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