Legal Separation Agreement Sample
New York State Courts · Family Law
Copy of the court's form from nycourts.gov, taken October 21, 2026. See it on the court's site ↗
Sample short-form separation agreement for spouses with no children, with support provisions and the terms on which they will live apart, signed and acknowledged as a contract between the spouses. It is a sample to adapt, not a court form.
This form must be printed and filled by hand, or opened in Adobe Acrobat.