Published: 06/2020, CN: 12620 page 2 of 3
☐ 10. I was not under the influence of any drug or alcohol at the time of I negotiated, read
and signed the Agreement that would impair my ability to understand the nature of
☐ 11. Alimony (check one)
☐ a. Alimony is not being paid as part of the Agreement. I acknowledge that my
lifestyle can be maintained as it was during the marriage or I understand that my
lifestyle cannot be maintained and want to enter into the Agreement knowing
that my lifestyle cannot be maintained; or
☐ b. Alimony is being paid as part of the Agreement. I acknowledge that my lifestyle
can be maintained as it was during the marriage or I understand that my lifestyle
will not be maintained and want to enter into the Agreement knowing that my
lifestyle cannot be maintained.
☐ i. Attached to this certification is a Marital Lifestyle Statement (only needed
by one party) which is a Case Information Statement that reflects the
income and expenses of the parties during the marriage.
☐ ii. Parties must indicate that they agree that the Marital Lifestyle Statement
correctly reflects their expenditures during the marriage.
☐ iii. Attached is a current, less than one year old, Case Information Statement.
☐ 12. The Agreement incorporates all the terms of the agreement and that there are no
remaining issues or side agreements not contained in the Agreement.
☐ 13. I am are aware that I am waiving the right to have the judge decide the issues.
☐ 14. I have no other prior or pending court cases with the other party.
☐ 15. I have the following prior and/or pending court cases with the other party in this or
any other jurisdiction. (Include the caption, docket number and a brief description
of the status of the cases.)
☐ 16. No property was acquired during the marriage that is subject to equitable
distribution unless a final order or Agreement has been entered that resolved this
☐ 17. I am not seeking child support, custody, or any other form of relief unless a final
order has been entered that resolved these issues.