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

Whereas, the parties are husband and wife and irreconcilable disputes and difference having arisen between them they have heretofore separated and been living separate and apart; and

Whereas, difference have arisen between the parties with respect to their rights, privileges, personal liberty and obligations and conduct with respect to one another and to other persons; and

Whereas, the parties hereto are desirous of reaching an agreement on these points,

Now, Therefore, in consideration of the foregoing premises and the mutual promises, concessions and agreements herein, it is agreed as follows:

1. Neither of the parties will interfere or intermeddle with the other in his or her respective liberty, conduct or action.

2. Each party 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 hereto 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 that he will pay or cause to be paid or make provisions for the payment to the Wife.............of dollars then first day of each and every month during the term of her natural life or until she shall marry and the Wife agrees to accept such payment if, when and so long as made in full satisfaction of her claim for support and maintenance under this agreement

4. The Husband shall have sole charge and custody of......

.........., the child of the parties. As to................., the child of the Wife, who has heretofore been adopted by the Husband pursuant to the statute in such case made and provided, for the present and until otherwise requested by the Wife, the Husband shall have the custody without prejudice to the right of the Wife to said child under the provisions of Section 114 of the Domestic Relations Law of the State of New York. The relinquishment by the Wife of the custody of the child....

............shall not be deemed to give the Husband any authority to consent to the adoption of the said child by others or to appoint in case of his death any guardian for such child to the exclusion of the Wife. The Wife shall have the privilege of seeing................wherever the child may be for a period of................in each..........and

5. The Husband agrees that he will immediately notify the Wife of any serious illness or accident to either of the children while in his care.

6. The Wife agrees not to incur any liabilities or incur any debts in the name of the husband.