State of Tennessee Court County

(Must Be Completed) (Must Be Completed)

Divorce Agreement File No.
(Must Be Completed)
(Marital Dissolution Agreement)
Division/Part
(Form 5) (Large Counties Only)
Plaintiff
(Name: First, Middle, Last of Spouse Filing the Divorce)
Defendant
(Name: First, Middle, Last of the Other Spouse)

This form explains how you and your spouse will divide your property and debts.
You must file this form with your Request for Divorce, Form 1.
Warning! Divorce cases can be hard.
It is always good to talk with a lawyer, if possible.
For information on how to get legal help, call 1-844-Help4TN (1-844-435-7486).

Check “yes” or “no” for each question below.

Does one or more of the children born while you were married have a different birth father?
 Yes  No
Does somebody else have a court order giving them custody or visitation of the children?
 Yes  No
Is a spouse pregnant?
 Yes  No
Does either spouse have a pension or retirement plan? This includes any retirement except
Social Security. If you have any questions, see a lawyer.
 Yes  No
Does either spouse own a business?
 Yes  No
Does either spouse have real property (real property is houses, land, mobile homes
that are permanently attached to the ground, condominiums, and cooperatives).
 Yes  No
If you checked “Yes” for any of the questions above, you cannot use these forms. Please talk to a lawyer.

Do you and your spouse agree on everything in the Parenting Plan?

 Yes  No
If you checked “No” for the question above, you cannot use these forms. Please talk to a lawyer.

Plaintiff: Initials________ Date Signed: ________________________ Defendant: Initials _____ Date Signed: ____________________

January 2017 (Form 5) Divorce Agreement Page 1 of 9

We promise the Court that: (Check Yes or No for each box)
1. We are the Plaintiff and Defendant listed above. We are filing a Request for Divorce in the county
and court listed above. We can no longer get along as spouses. We understand our marriage rights
and duties. We want to get an agreed divorce.
 Yes  No
2. We agree on everything in the Request for Divorce. The Request for Divorce does not have to
be served, and there is no need to file an Answer.
 Yes  No
3. Each of us has read this whole Divorce Agreement. We agree it is fair. We agree that each of us has
told the other all information on assets and/or debts that we each have. We understand that the
Divorce Agreement will become part of our Final Divorce Order.
 Yes  No
4. My spouse and I have children together who are under 18, in high school or disabled.
 Yes  No
Children together means children you had together that were born before your marriage AND all
children born or adopted during the marriage. This includes all children either spouse had
during the marriage. The Court can decide issues about each child under age 18, in high school,
or disabled.
5. We have entered into a Permanent Parenting Plan. It is attached and part of this Marital Dissolution
Agreement. We agree the Plan is in the best interest of the children. We understand the court will
make the final decision about parenting issues.
 Yes  No
6. No one made us sign this Agreement. We will sign any other papers needed to carry out this
Agreement.
 Yes  No
7. Neither spouse is pregnant.
 Yes  No

8. We agree that this Request for Divorce will take effect only if the Court finds it fairly divides our
assets and debts and fully provides for the care and support of our children and if the Court grants
a divorce.
 Yes  No

If you checked “No” on any box, you cannot use any of these forms to file for a divorce. If you have
any questions about the Request for Divorce, or about what might happen if either of you change
your mind, you need to speak with a lawyer before signing it.

Plaintiff: Initials________ Date Signed: ________________________ Defendant: Initials _____ Date Signed: ____________________

January 2017 (Form 5) Divorce Agreement Page 2 of 9

Plaintiff’s Personal Property

The Plaintiff will own the following property:

a. Vehicles (cars, motorcycles, trucks, boats, etc.)
Year Make Model VIN #

Vehicle 1
Year Make Model VIN #

Vehicle 2
Year Make Model VIN #

Vehicle 3

b. Other personal property like bank accounts, cash, furniture, jewelry, trailers, etc., not houses or
land!
Bank or Financial Account Number
Type of Account Account Balance
Institution (Last four Digits)
Check Account
Savings Account
Money Market
Account
Other Account
Other Account

Describe other personal property:

c.  All personal property the Plaintiff has now is his/hers.

If you need more lines, copy this page. Make sure it is included when you file this paper.

Plaintiff: Initials________ Date Signed: ________________________ Defendant: Initials _____ Date Signed: ___________________

January 2017 (Form 5) Divorce Agreement Page 3 of 9

Defendant’s Personal Property
The Defendant will own the following property:
a. Vehicles (cars, motorcycles, trucks, boats, etc.)
Year Make Model VIN #
Vehicle 1
Year Make Model VIN #

Vehicle 2
Year Make Model VIN #

Vehicle 3

b. Other personal property like bank accounts, cash, furniture, jewelry, trailers, etc., not houses or
land!

Bank or Financial Account Number

Type of Account Account Balance
Institution (Last four Digits)
Check Account
Savings Account
Money Market
Account
Other Account
Other Account

Describe other personal property:

c.  All personal property the Defendant has now is his/hers.

If you need more lines, copy this page. Make sure it is included when you file this paper.

Plaintiff: Initials________ Date Signed: ________________________ Defendant: Initials _____ Date Signed: ____________________

January 2017 (Form 5) Divorce Agreement Page 4 of 9

Debt
Notice: The Final Decree does not necessarily affect the ability of a creditor to proceed against a party
or a party's property, even though the party is not responsible under the terms of the decree for an
account, any debt associated with an account or any debt. It may be in a party's best interest to
cancel, close or freeze any jointly held accounts. T.C.A. §36-4-134.
What this means: This Order does not protect you against creditors. They may try to collect from
you, even if your spouse is supposed to pay the debt. It may be best to cancel, close, or freeze any
accounts you have together.

Plaintiff will pay all debts he or she has made since separating from the other spouse.
He or she will also pay for the following debts:
List all loans, Account Number Name on the
Name of Creditor
including car notes, (last four digits) account Amount still
(person or
credit card, cash owed
company you owe)
advance debts
1.
$
2.
$
3.
$
4.
$

If you need more lines, copy this page. Make sure it is included when you file this paper.

Are any of these debts listed above joint debts? It is a joint debt if both spouses signed a Note
or legal paper to pay the debt.

The Plaintiff will do his or her best to refinance or pay off these joint debts.

The Plaintiff has (choose one):  90 days 180 days  1 year from the date
the Court approves this Agreement to do so or otherwise take the other spouse's name off of these
joint debts.

What if the Plaintiff does not refinance or pay off the joint debts in that time? Then the other spouse may
take him or her back to Court. The Court may order the Plaintiff's assets sold to pay off the joint debt(s).

Plaintiff: Initials________ Date Signed: ________________________ Defendant: Initials _____ Date Signed: ____________________

January2017 (Form 5) Divorce Agreement Page 5 of 9

 Defendant will pay all debts he or she has made since separating from the other spouse. He or
she will pay for the following debts:

List all loans, Account Number Name on the

Name of Creditor
including car notes, (last four digits) account Amount still
(person or
credit card, cash owed
company you owe)
advance debts
1.
$
2.
$
3.
$
4.
$

If you need more lines, copy this page. Make sure it is included when you file this paper.

Are any of these debts listed above joint debts? It is a joint debt if both spouses signed a Note or legal
paper to pay the debt.
The Defendant will do his or her best to refinance or pay off these joint debts.

The Defendant has (choose one):  90 days  180 days  1 year from the
date the Court approves this Agreement to do so or otherwise take the other spouse's name off
of these joint debts.

What if the Defendant does not refinance or pay off the joint debts in that time? Then the other spouse
may take him or her back to Court. The Court may order the Defendant's assets sold to pay off the joint
debt(s).

We Both Agree on How to Divide the Debts

(Hold Harmless Provision)
Both the spouses agree to divide their debts as listed above. The Plaintiff agrees to pay all the debts listed
under "Plaintiff’s Debts.” The Defendant agrees to pay all the debts listed under “Defendant’s Debts.” The
Plaintiff will not try to make the Defendant pay his/her debts. The Defendant will not try to make the Plaintiff
pay his/her debts. The Plaintiff and Defendant understand that creditors can try to collect from both of them. A
creditor may get one spouse to pay the other spouse’s debt, even after the divorce is final. If that happens, the
spouse who has agreed to pay the debt will pay the other spouse back. He or she will pay back any payments
and reasonable lawyer’s fees the spouse paid. He or she will pay back any costs of trying to stop a creditor
from collecting the debt.

Plaintiff: Initials________ Date Signed: ________________________ Defendant: Initials _____ Date Signed: ____________________

January 2017 (Form 5) Divorce Agreement Page 6 of 9

Alimony (check one):
Warning! This section can be very hard. Please talk with a lawyer if you need help with this section.
Alimony can only be changed if there are significant life changes. Sometimes it cannot be changed
at all. You have to get a court order to change alimony.
If you want alimony but do not agree on all the sections below, you cannot use this form.
You must fill out each section.
 Neither spouse wants alimony
OR
1. The  Plaintiff  Defendant agrees to pay (amount): $ .
2. We agree that the alimony (check all the blocks that are true for your agreement):
 Will be paid until this date ________________________________________

 Will end when the one who gets the alimony dies or gets married again

 Will end when the one who gets the alimony finishes school, or on ,
whichever date comes first.
 Or if this happens _____________________________________________________

 Will not be modified.

The court can modify the alimony due to significant changes in our lives, or if the
person receiving alimony lives with another person, with or without a romantic
relationship.

3. We agree that the alimony will be paid (you must check one):
 Weekly
 Monthly
 Other:
 Lump sum paid all at one time

Important: Both of us understand alimony may change our federal taxes. Unless we specifically agree
otherwise, the payor will be able to deduct it on his/her tax return and the person receiving it will have to
declare it as income. Our initials at the bottom of this page show we understand this. We agree we are
responsible for knowing, understanding and accepting this.

Plaintiff Initials________ Date Signed: ________________________ Defendant Initials _____ Date Signed: ____________________

January 2017 (Form 5) Divorce Agreement Page 7 of 9

 Name Change
Check below to change a spouse’s name back to a name used before this marriage (maiden name
or previous married name). A government agency or other business may need proof of this name
change. If so, give them a filed copy of this form.
 Plaintiff
First Middle Last
 Defendant
First Middle Last
Court Costs will be paid by (check one)
 Plaintiff
 Defendant
 Plaintiff and Defendant will each pay half
 Other (explain):

Waiver of Service

By signing this Agreement, the Plaintiff and Defendant agree they do not have to serve each other with
divorce papers. This form is only good for 180 days after the last spouse signs it. Your final hearing must
be within those 180 days. If the 180 days has passed, you will have to fill out, sign, and file this form again.
The spouses understand that they do not have to file an Answer to a Complaint for Divorce.

Entire Agreement
This document says everything the Plaintiff and Defendant agreed to in this divorce. If they agreed
with each other about anything else, the court cannot make them do it.

Warning - Changes (Modification)

This form is a legal contract. It is very important this contract is completely filled out. Make sure
that you are OK with everything that is in it before you sign it. Speak to a lawyer before signing or if
you have any questions.

Plaintiff: Initials________ Date Signed: ________________________ Defendant: Initials _____ Date Signed: ____________________

January 2017 (Form 5) Divorce Agreement Page 8 of 9

Read below, but only sign in front of a notary. Read below, but only sign in front of a notary.
You may sign at a different time than your You may sign at a different time than your
spouse, if you want. spouse, if you want.
Plaintiff Defendant
I know that Tennessee has laws against lying I know that Tennessee has laws against lying
on purpose (perjury). I swear and affirm that: on purpose (perjury). I swear and affirm that:
• As far as I know, the information on this form is • As far as I know, the information on this form is
true. true.
• I have told my spouse about all property and all • I have told my spouse about all property all and
debts that I know about. I have not kept any debts that I know about. I have not kept any
property or debts a secret from my spouse before property or debts a secret from my spouse
I signed this agreement. before I signed this agreement.
• This is everything we have agreed to. • This is everything we have agreed to.
• Any Agreements we have that are not listed above • Any Agreements we have that are not listed above
are no longer any good. are no longer any good.
I understand that even if one of us changes his I understand that even if one of us changes his
or her mind after we both sign it, the Court may or her mind after we both sign it, the Court may
still enforce the Request for Divorce. still enforce the Request for Divorce.
SWORN to and SUBSCRIBED before me, on SWORN to and SUBSCRIBED before me, on

(date):____________________________________ (date): ___________________________________

MM/DD/YYYY MM/DD/YYYY

Signed at (city): Signed at (city):

State of Tennessee, County of State of Tennessee, County of

By (Plaintiff): By (Defendant):

Signature of Notary Public, State of Tennessee Signature of Notary Public, State of Tennessee
My commission expires on: My commission expires on:

MM/DD/YYYY MM/DD/YYYY

(Notary’s seal) (Notary’s seal)

By signing this Agreement, the spouses agree not to serve each other with divorce papers. They will give
this Agreement to a court within 180 days. The 180 days starts when both of them have signed the
Agreement. They agree that they do not need to file an answer to the divorce complaint.

Plaintiff: Initials________ Date Signed: ________________________ Defendant: Initials _____ Date Signed: ____________________

January 2017 (Form 5) Divorce Agreement Page 9 of 9