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| , Jul. 20, 2008 |
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The following form is intended for illustrative purposes only. You and your attorney can use this sample as a guide in drafting a cohabitation agreement that best protects your interests and complies with the laws in effect where you live.
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________________________________________, Cohabitant No. 1, and ____________________________________, Cohabitant No. 2, hereinafter jointly referred to as the Cohabitants, who now live /will live together in the future (circle one) at __________________________, in the city of __________________, county of ________________, state of ______________, hereby agree on this _____ day of ______________, in the year ______, as follows:
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| Monthly Expenses | Cohabitant No. 1 | Cohabitant No. 2 | |
| Rent or Mortgage | $_______________ | $_______________ | |
| Utilities: | |||
| Telephone | $_______________ | $_______________ | |
| Gas | $_______________ | $_______________ | |
| Electricity | $_______________ | $_______________ | |
| Water & Sewer | $_______________ | $________________ | |
| Garbage Collection | $_______________ | $_______________ | |
| Cable Television | $_______________ | $_______________ | |
| Cellular Phone | $_______________ | $_______________ | |
| Internet Service | $_______________ | $_______________ | |
| Property Taxes | $_______________ | $_______________ | |
| Insurance: | |||
| Homeowners/Renters | $_______________ | $_______________ | |
| Auto(s) | $_______________ | $_______________ | |
| Recreational Vehicle | $_______________ | $_______________ | |
| Debt Payments: | |||
| Vehicle #1 | $_______________ | $_______________ | |
| Vehicle #2 | $_______________ | $_______________ | |
| Home Equity Loan | $_______________ | $_______________ | |
| Other Loans | $_______________ | $_______________ | |
| Credit Card #1 | $_______________ | $_______________ | |
| Credit Card #2 | $_______________ | $_______________ | |
| Credit Card #3 | $_______________ | $_______________ | |
| Day Care | $_______________ | $_______________ | |
| Transportation Expenses: | |||
| Gasoline | $_______________ | $_______________ | |
| Parking/Commuting | $_______________ | $_______________ | |
| Vehicle Maintenance | $_______________ | $_______________ | |
| Licenses | $_______________ | $_______________ | |
| Food: | |||
| Groceries | $_______________ | $_______________ | |
| Take-out Food | $_______________ | $_______________ | |
| Restaurants | $_______________ | $_______________ | |
| School Lunches | $_______________ | $_______________ | |
| Household Expenses: | |||
| Cleaning Supplies | $_______________ | $_______________ | |
| Cleaning Service | $_______________ | $_______________ | |
| Yard Maintenance | $_______________ | $_______________ | |
| Home Maintenance | $_______________ | $_______________ | |
| Home Security | $_______________ | $_______________ | |
| Home Improvements | $_______________ | $_______________ | |
| Home Furnishings | $_______________ | $_______________ | |
| Appliances | $_______________ | $_______________ | |
| Personal Expenses: | |||
| Entertainment | $_______________ | $_______________ | |
| Travel | $_______________ | $_______________ | |
| Gifts | $_______________ | $_______________ | |
| Hobbies | $_______________ | $_______________ | |
| Babysitting | $_______________ | $_______________ | |
| Pet-care Costs | $_______________ | $_______________ | |
| Donations | $_______________ | $_______________ | |
| Other Expenses | $_______________ | $_______________ | |
| $_______________ | $_______________ | ||
| $_______________ | $_______________ | ||
| $_______________ | $_______________ | ||
| TOTAL EXPENSES: | $_______________ | $_______________ | |
I HAVE READ THE ABOVE AGREEMENT, I HAVE TAKEN TIME TO CONSIDER ITS IMPLICATIONS, I FULLY UNDERSTAND ITS CONTENTS, I AGREE TO ITS TERMS, AND I VOLUNTARILY SUBMIT TO ITS EXECUTION. | |||
| ____________________________________ Cohabitant No. 1 |
______________________________ Cohabitant No. 2 | ||
| Witnessed by: | |||
| ____________________________________ (Witness or counsel signature) |
______________________________ (Witness or counsel signature) | ||
| [NOTARY PUBLIC MAY AFFIX STAMP HERE] | |||