TULSA COUNTY ONLY

MY NAME (full name; do not use only initials)

____________________________________________________________________________________________

(first) (middle) (last)

SPOUSE'S NAME (full name; do not use only initials)

____________________________________________________________________________________________

(first) (middle) (last)

Date of marriage: ___/___/___ City_______________ County____________________ State____

I have you lived in Oklahoma at least 6 months and in Tulsa County for at least 30 days.

Grounds for divorce is incompatibility.

CHILDREN: NAMES (First, Middle Last) BIRTH DATES AGE SOCIAL SEC. #

____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

I am not (or my wife is not) pregnant.

There are no other custody cases concerning our children pending anywhere.

Addresses where children have lived in the last 5 years and names of others living at same address:

1. _____________________________________________________________________________________

2. _____________________________________________________________________________________

3. _____________________________________________________________________________________

Former last name if wife wishes it restored? ______________________________________________

We have not filed bankruptcy in past 8 years// Our Bankruptcy case was filed on ___________ at _______________

^{Date Location}

We are not receiving any public assistance.

Present address:

________________________________________________________________________________

(street) (city) (state) (zip)

Date of Birth _____________ Soc.Sec.No.: ___________________

Telephone numbers: Home (__)________ Work (__)________ Fax (__)________

Mobile (__)________ E-Mail address__________________________________________

Permanent Mailing Address:

________________________________________________________________________________

(street) (city) (state) (zip)

Present address:

_____________________________________________________________________________

(street) (city) (state) (zip)

Date of Birth _____________ Soc.Sec.No.: _________________

Telephone numbers: Home (__)________ Work (__)________ Fax (__)________

Mobile (__)________ E-Mail address__________________________________________

Permanent Mailing Address:

________________________________________________________________________________

(street) (city) (state) (zip)

We have agreed on the following custody arrangement: ____________________________________

______________________________________________________________________________

We have agreed upon the following visitation arrangement: _______________________________

______________________________________________________________________________

We have agreed that _________________ will pay child support to ______________________.

Gross (before taxes) Monthly Income: Husband $ ___________ Wife $ _____________

Monthly cost for child care: $ __________ Health insurance (children only) $ _____________

Deviations from Guidelines: ___________________________________________________

The Tax Exemption for the children will be awarded to __________________________________________

Name and address of employer of spouse who will pay child support: _____________________

______________________________________________________________________________

Address: ________________________________________________________

Legal description: ______________________________________________

Name of first mortgage holder: ________________________________________

Name of second mortgage holder: ________________________________________

We have agreed that ______________________________ will have temporary possession of this property.

We have agreed that _______________________________________ will receive this property.

We have agreed that _________________________ will be responsible for the debt on this property.

Address:_________________________________________________________

Type (e.g. second home, lake home, vacant land, rental property): _______________________

Legal description: ______________________________________________

Name of first mortgage holder: __________________________________________

Name of second mortgage holder: ________________________________________

We have agreed that ______________________________ will have temporary possession of this property.

We have agreed that _______________________________________ will receive this property.

We have agreed that _________________________ will be responsible for the debt on this property.

Husband will receive: Year ________ Make ______________ Model _____________

License tag ___________ VIN _______________________________

Wife will receive: Year ________ Make ______________ Model________________

License tag ___________ VIN _______________________________

_______ will receive: Year _______ Make ______________ Model _____________

License tag ___________ VIN _______________________________

All other personal property has been divided (or will be divided before the Decree is entered) so that each will be awarded all the property in his or her possession, except:

____________________________ will be awarded to _________________________________

____________________________ will be awarded to _________________________________

Each party shall retain and is awarded all the right, title and interest in and to her own life insurance policies, pension, profit sharing plan, profit incentive plan, thrift plan, 401K plan, stock purchase plan, individual retirement account, HR 10 plan, Keogh plan, if any, arising out of that party's employment and all bank accounts and other intangible personal property in that party?s name. Neither party shall have any interest in such property of the other.

I will be responsible for the following debts:

Creditor Account Number

_________________ ___________________________

_________________ ___________________________

_________________ ___________________________

_________________ ___________________________

My spouse will be responsible for the following debts:

Creditor Account Number

_________________ ___________________________

_________________ ___________________________

_________________ ___________________________

_________________ ___________________________

[ ] Neither party shall pay alimony to the alimony to the other OR

[ ] _____________ shall pay alimony to _______________ in the total amount fo $______________,

payable as follows: ___________________________________________________________________________

[ ] Each party shall pay his or her own attorney fees OR

[ ] _______________ shall pay $______________ to _______________ for attorney fees incurred.

List any additional information or changes from the above stated terms that you have agreed upon:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

All of the above information and terms for my divorce are true and correct and agreed to by my spouse.

Date: ________ ___________________________________

                                               Signature