Agreement made........between........hereinafter referred to as the Husband, and........., hereinafter referred to as the Wife, Witnesseth:

Whereas, the parties hereto are Husband and Wife, and because of irreconcilable disputes and differences which have arisen between them, have heretofore separated and have been and are living separate and apart, and

Whereas, differences have arisen between the parties with respect to their rights and privileges and with respect to the amounts which the Husband shall contribute to the support of the Wife, and

Whereas, the Husband represents and warrants, as the basis upon which this agreement is made, and for the purpose of inducing the Wife to sign this agreement, that his total income from all sources amounts to not more than the sum of $.........per year.

Whereas, the Wife, relying upon this information is willing that her right to support from the Husband should be made upon this statement of the facts by the Husband,

Now, Therefore, in Consideration of the premises and of the mutual promises of the parties, It Is Agreed As Follows:

1. Each of the parties agree not to interfere or intermeddle with the other in his or her respective liberty, conduct or action.

2. Each of the parties agrees that the other may at any and all times live separate and apart and may reside and be in such places and in such families and with such relations, friends and acquaintances and may follow and carry on such business, occupation or profession as he or she may choose, and in general, that the parties are to have full and independent liberty and freedom of action and conduct, so far as their mutual obligations, duties and responsibilities are involved.

3. The Husband agrees to pay to the Wife, $........upon the first day of each and every month during her life. The Wife agrees to accept said payment, if and when and so long as made, in full satisfaction of her claim for support and maintenance by the Husband. If the Husband's income from all sources of whatsoever nature, should for three successive months, average pro rata for the current calendar year less than $........and more than $........than the amount which the Husband shall be obliged to pay thereafter and the amount which the Wife shall thereafter accept in lieu of maintenance and support from the Husband as herein provided, shall instead of $.......

per month, be........per centum of such amount as the

Husband's current calendar monthly income may be. This contingency is hereinafter described as the "first contingency." If the Husband's income from all sources of whatsoever nature should, for three successive months, average pro rata, for the current calendar year $........or less, than the amount which the Husband shall be obliged to pay thereafter, and the amount which the Wife will thereafter accept, in lieu of maintenance and support from the Husband as herein provided, shall be per month instead of..........per centum of such amount as the Husband's current calendar monthly income may be, one-third of said amount. This contingency is hereafter described as the "second contingency." As a condition precedent to any reduction in either contingency above provided for, the Husband shall submit a sworn statement of his current income. The said reduction shall continue in the event of the first contingency, only so long as the Husband's current income shall be per month less than........% of $........, and in the event of the second contingency, only so long as the

Husband's current income shall be per month..........% of $.........or less. Such respective reductions shall cease at any time when his current income during any month shall be in the first contingency.........% of $............ If at any time during any year, the Husband shall avail himself of either of the reductions herein provided for, then upon January first of the ensuing year, the Husband shall submit to the Wife a sworn statement of his total income in the previous year showing his income for each month of that year.

In the event of any breach of the terms of this paragraph or agreement requiring the furnishing of sworn statements as to the Husband's income, or in the event of any misstatement or false representation by the Husband as to his income, the sum of $........for each and every month shall be due and payable, irrespective of the actual income of the Husband or whether reduced payments have been made and accepted, and the Wife shall be entitled to the difference between the amount paid and accepted and the said $.........per month.

4. The payments and statements hereby required shall be made and be due commencing as of...............

5. Payments required hereunder shall be made to the Wife at.........or to.........her attorney at........, or to any other attorney or agent for the Wife, whom she may hereafter appoint by written notice.

6. The Wife agrees not to incur any liabilities or incur any debts in the name of the Husband as long as he shall faithfully perform all the provisions of this agreement.