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~-FILED-
AUG~4 2022
COMMONWEALTH of MASSACHUSETTS =
The Trial Court SMG
Probate and Family Court Department
Worcester ss. Docket No. 21544
Gregorio Portorreal Reyes
9 » Plaintiff/Petitioner
Patricia Diane Galvan nae
Defendant/Petitioner
SEPARATION AGREEMENT APPLICABLE TO ALL DIVORCES
Gregorio Portorreal Reyes
AGREEMENT made between
(Name of Husband)
of 60 Pine Street 2nd Floor Fitchburg, MA 01420
(Street Address) (City/Town, State. Zip)
Patricia Diane Galvan
(referred to as the Husband), and
(Name of Wife)
of 19 Crescents Heights Fitchburg, MA 01420
(Street Address) (City, Town, State, Zip)
(referred to as the Wife.)
_... Fitchb MA
The Husband and Wife were married in {“°™P"9
(City/Town & State)
on 04/09/2016 19 Crescents Heights
and last lived together as Husband and Wife at
(Date of Marriage) (Street Address)
Fitchburg, MA 07/20/2021
on
(City/Town, State) (Date of Separation)
No children were born of this marriage.
None of the children born of this marriage are under the age of eighteen years or
are dependent on the parties for support
The following dependent child[ren] was/were born of this marriage (ist names and
dates of birth on the following page):Separation Agreement - Page Seven
SUBMISSION OF AGREEMENT TO COURT
The Husband and Wife each agree that this Separation Agreement shall be submitted
to the Worcester Division of the Probate and Family Court for a judge's approval of the
terms and entry of a Judgment of Divorce.
The parties further agree that the terms and provisions of this Separation Agreement
shall be: (Choose one of the following)
Kt incorporated and merged into the Judgment of Divorce Nisi of the Court.
Qo incorporated, but not merged, into the Court's judgment, and shall survive
and remain as an independent contract, except for the terms and provisions
relating to the care, custody, support and education of the minor child[ren],
{attach Schedule A) which terms and provisions shall merge in said
Judgment.
C_ incorporated, but not merged, into the Judgment of Divorce Nisi, and shall
remain as an independent contract between the parties.
EXECUTION
Signed on_OC#-14-202/ G Qlarnroel
(Date) (Husband)
regorio Portorreal Reyes
Signed on OL-~Q\- OQ © tA
(Date) (Wife)
Patricia Diane Galvan
Commonwealth of Massachusetts
Worcester ss. Date: tol 14] 2021
Then personally appeared the above-named Gregorio Portorreal Reyes , and
acknowledged that - he - sk@ - signed this separation agreement as - his - DS -
free act and deed.
Danilsa Fereras
Notary Public - My Commission Expires:07/iy[2028
DANILSA A. FERRERAS
Notary Public
Ch} ‘Commonwealth of Massachusetts
UP en My Commission Expires
- duly 14, 2028Separation Agreement - Page Two
4) n/a =no minor children date of birth
2) date of birth
3) date of birth
4) date of birth
5) date of birth
6) date of birth
This Separation Agreement is made in order to settle and determine:
a) the property and support rights of the husband and wife; and
b) the care, custody, support, maintenance and education of the minor
and/or dependent child[ren] of this marriage (attach Schedule A); and
c) all other rights and obligations arising from the marital relationship.
In consideration of the mutual promises contained in this Separation Agreement, the
Husband and Wife agree that:
PROPERTY DIVISION AND DEBTS
A. Real Estate:
x Neither party holds any interest in real estate.
C1 The parties have already divided their interest in the marital home located
at:
1 The disposition of the parties' real estate shall be as follows:Separation Agreement - Page Three
B. Personal Property:
The parties hereby agree that:
JX there has been a full and satisfactory division of all other personal
property and each party shall hold full right, title and interest in all items
of personal property now in his/her possession.
1 Husband shall have full right, title and interest in the following items:
Qo Wife shall have full right, title and interest in the following items:
C. PensionIRetirement Benefits:
JX The parties have no retirement or pension benefits to be divided.
O The retirement or pension benefits of the parties shall be divided as
follows:
D. Stocks/Bonds
x The parties have no interest in stocks or bonds.
0) The stocks and bonds of the parties shall be divided as follows:Separation Agreement - Page Four
E. Bank Accounts:
The parties hereby agree that the:
x Husband shail have full right, title and interest in the following bank
accounts: all accounts in husband's name
YX Wife shall have full right, title and interest in the following bank accounts:
all accounts in wife's name
F. Debt:
be The Husband will be responsible for his individual debts and liabilities as
listed on his financial statement dated / /
x The Wife will be responsible for her individual debts and liabilities as listed
on her financial statement dated / /
O1 The marital debts of the parties shall be paid as follows:
ALIMONY
1 Each party hereby waives past and present alimony from the other and
reserves the matter of future alimony for consideration by the Court
should the need arise.
K Each party hereby waives past, present, and future alimony from the
other.
D the shall pay to the the sum of $.
(Husband/Wife) (Husband/Wife)
each and every week, beginning - / L ,- as alimony.
Payments of alimony shall end:
Oo on ff
o when the following event(s) occur(s):fy
NL
Separation Agreement - Page Five
HEALTH INSURANCE FOR PARTIES
The Wife's health insurance coverage will be provided:
(by the Wife
O by the Husband
C by the Husband for so long as it is available to him, and if there is any
additional cost to continued coverage for the insurance:
O the additional out of pocket cost shall be paid by - Husband - Wife
U the Wife shall have the option of choosing to provide her own health
insurance coverage and shall notify the Husband in writing if she elects to
do so
The Husband's health insurance coverage will be provided:
(by the Husband
0 by the Wife
by the Wife for so long as it is available to her, and if there is any additional
cost to continued coverage for the insurance:
O the additional out of pocket cost shall be paid by - Husband - Wife
Othe Husband shail have the option of choosing to provide his own health
insurance coverage and shall notify the Wife in writing if he elects to do
so
The cost of all reasonable uninsured and unreimbursed medical, dental, hospital,
optical, prescription medication and therapeutic counseling services for the Wife shall
be paid: :
& by the Wife o % by Wife; Oo % by Husband
The cost of all reasonable uninsured and unreimbursed medical, dental, hospital,
optical, prescription medication and therapeutic counseling services for the Husband
shall be paid:
by the Husband Oo % by Husband; oO % by Wife
The part of your Separation Agreement involving health care coverage is an
important provision. A guide has been developed by Health Law Advocates (HLA)
and the Massachusetts Attorney General's Office to inform divorce litigants of their
health insurance rights and options. "Staying Healthy: A Guide to Keeping Health
Insurance After Divorce" is available at the Probate Court or on the internet at
www.hla-inc.org/public/staying healthO2.pdf.—/
Separation Agreement - Page Six
LIFE INSURANCE
(The Husband shall maintain life insurance in the face amount of:
$. , naming as the beneficiary, and
shall be required to keep the life insurance in effect until
O The Wife shall maintain life insurance in the face amount of:
$. , naming as the beneficiary, and
shall be required to keep the life insurance in effect until
we Neither party shall be required to maintain life insurance for the benefit of
the -other.
OTHER PROVISIONS.
n/a - no other provisions.
GOVERNING LAW
This Separation Agreement shall be construed and governed according to the laws of
the Commonwealth of Massachusetts.
FULL DISCLOSURE OF ASSETS AND LIABILITIES
The Husband and Wife hereby represent that they have each made full disclosure to
the other party of their individual assets. Each party represents that s/he has provided
the other with a current financial statement on the form promulgated pursuant to
Supplemental Probate Court Rules, Rule 401, which discloses fully and completely all
of her/his income, expenses, assets and liabilities. By executing this Separation
Agreement, the parties represent that the terms and provisions of this agreement are
fair, just and reasonable and are not the product of fraud, coercion or undue influence,
and that each signs this agreement freely and voluntarily.Separation Agreement - Page Eight
Commonwealth of Massachusetts
Worcester 8S. Date: / | 3 / / a2
Then personally appeared the above-named Patricia Diane Galvan ,and
acknowledged that - € - she - signed this separation agreement as - Big - her -
free act and deed.
Lh he dn.
Notary Public - My Commission Expires: Laos
Heidi E. Deluco
NOTARY PUBLIC
Preview
~-FILED- AUG~4 2022 COMMONWEALTH of MASSACHUSETTS = The Trial Court SMG Probate and Family Court Department Worcester ss. Docket No. 21544 Gregorio Portorreal Reyes 9 » Plaintiff/Petitioner Patricia Diane Galvan nae Defendant/Petitioner SEPARATION AGREEMENT APPLICABLE TO ALL DIVORCES Gregorio Portorreal Reyes AGREEMENT made between (Name of Husband) of 60 Pine Street 2nd Floor Fitchburg, MA 01420 (Street Address) (City/Town, State. Zip) Patricia Diane Galvan (referred to as the Husband), and (Name of Wife) of 19 Crescents Heights Fitchburg, MA 01420 (Street Address) (City, Town, State, Zip) (referred to as the Wife.) _... Fitchb MA The Husband and Wife were married in {“°™P"9 (City/Town & State) on 04/09/2016 19 Crescents Heights and last lived together as Husband and Wife at (Date of Marriage) (Street Address) Fitchburg, MA 07/20/2021 on (City/Town, State) (Date of Separation) No children were born of this marriage. None of the children born of this marriage are under the age of eighteen years or are dependent on the parties for support The following dependent child[ren] was/were born of this marriage (ist names and dates of birth on the following page):Separation Agreement - Page Seven SUBMISSION OF AGREEMENT TO COURT The Husband and Wife each agree that this Separation Agreement shall be submitted to the Worcester Division of the Probate and Family Court for a judge's approval of the terms and entry of a Judgment of Divorce. The parties further agree that the terms and provisions of this Separation Agreement shall be: (Choose one of the following) Kt incorporated and merged into the Judgment of Divorce Nisi of the Court. Qo incorporated, but not merged, into the Court's judgment, and shall survive and remain as an independent contract, except for the terms and provisions relating to the care, custody, support and education of the minor child[ren], {attach Schedule A) which terms and provisions shall merge in said Judgment. C_ incorporated, but not merged, into the Judgment of Divorce Nisi, and shall remain as an independent contract between the parties. EXECUTION Signed on_OC#-14-202/ G Qlarnroel (Date) (Husband) regorio Portorreal Reyes Signed on OL-~Q\- OQ © tA (Date) (Wife) Patricia Diane Galvan Commonwealth of Massachusetts Worcester ss. Date: tol 14] 2021 Then personally appeared the above-named Gregorio Portorreal Reyes , and acknowledged that - he - sk@ - signed this separation agreement as - his - DS - free act and deed. Danilsa Fereras Notary Public - My Commission Expires:07/iy[2028 DANILSA A. FERRERAS Notary Public Ch} ‘Commonwealth of Massachusetts UP en My Commission Expires - duly 14, 2028Separation Agreement - Page Two 4) n/a =no minor children date of birth 2) date of birth 3) date of birth 4) date of birth 5) date of birth 6) date of birth This Separation Agreement is made in order to settle and determine: a) the property and support rights of the husband and wife; and b) the care, custody, support, maintenance and education of the minor and/or dependent child[ren] of this marriage (attach Schedule A); and c) all other rights and obligations arising from the marital relationship. In consideration of the mutual promises contained in this Separation Agreement, the Husband and Wife agree that: PROPERTY DIVISION AND DEBTS A. Real Estate: x Neither party holds any interest in real estate. C1 The parties have already divided their interest in the marital home located at: 1 The disposition of the parties' real estate shall be as follows:Separation Agreement - Page Three B. Personal Property: The parties hereby agree that: JX there has been a full and satisfactory division of all other personal property and each party shall hold full right, title and interest in all items of personal property now in his/her possession. 1 Husband shall have full right, title and interest in the following items: Qo Wife shall have full right, title and interest in the following items: C. PensionIRetirement Benefits: JX The parties have no retirement or pension benefits to be divided. O The retirement or pension benefits of the parties shall be divided as follows: D. Stocks/Bonds x The parties have no interest in stocks or bonds. 0) The stocks and bonds of the parties shall be divided as follows:Separation Agreement - Page Four E. Bank Accounts: The parties hereby agree that the: x Husband shail have full right, title and interest in the following bank accounts: all accounts in husband's name YX Wife shall have full right, title and interest in the following bank accounts: all accounts in wife's name F. Debt: be The Husband will be responsible for his individual debts and liabilities as listed on his financial statement dated / / x The Wife will be responsible for her individual debts and liabilities as listed on her financial statement dated / / O1 The marital debts of the parties shall be paid as follows: ALIMONY 1 Each party hereby waives past and present alimony from the other and reserves the matter of future alimony for consideration by the Court should the need arise. K Each party hereby waives past, present, and future alimony from the other. D the shall pay to the the sum of $. (Husband/Wife) (Husband/Wife) each and every week, beginning - / L ,- as alimony. Payments of alimony shall end: Oo on ff o when the following event(s) occur(s):fy NL Separation Agreement - Page Five HEALTH INSURANCE FOR PARTIES The Wife's health insurance coverage will be provided: (by the Wife O by the Husband C by the Husband for so long as it is available to him, and if there is any additional cost to continued coverage for the insurance: O the additional out of pocket cost shall be paid by - Husband - Wife U the Wife shall have the option of choosing to provide her own health insurance coverage and shall notify the Husband in writing if she elects to do so The Husband's health insurance coverage will be provided: (by the Husband 0 by the Wife by the Wife for so long as it is available to her, and if there is any additional cost to continued coverage for the insurance: O the additional out of pocket cost shall be paid by - Husband - Wife Othe Husband shail have the option of choosing to provide his own health insurance coverage and shall notify the Wife in writing if he elects to do so The cost of all reasonable uninsured and unreimbursed medical, dental, hospital, optical, prescription medication and therapeutic counseling services for the Wife shall be paid: : & by the Wife o % by Wife; Oo % by Husband The cost of all reasonable uninsured and unreimbursed medical, dental, hospital, optical, prescription medication and therapeutic counseling services for the Husband shall be paid: by the Husband Oo % by Husband; oO % by Wife The part of your Separation Agreement involving health care coverage is an important provision. A guide has been developed by Health Law Advocates (HLA) and the Massachusetts Attorney General's Office to inform divorce litigants of their health insurance rights and options. "Staying Healthy: A Guide to Keeping Health Insurance After Divorce" is available at the Probate Court or on the internet at www.hla-inc.org/public/staying healthO2.pdf.—/ Separation Agreement - Page Six LIFE INSURANCE (The Husband shall maintain life insurance in the face amount of: $. , naming as the beneficiary, and shall be required to keep the life insurance in effect until O The Wife shall maintain life insurance in the face amount of: $. , naming as the beneficiary, and shall be required to keep the life insurance in effect until we Neither party shall be required to maintain life insurance for the benefit of the -other. OTHER PROVISIONS. n/a - no other provisions. GOVERNING LAW This Separation Agreement shall be construed and governed according to the laws of the Commonwealth of Massachusetts. FULL DISCLOSURE OF ASSETS AND LIABILITIES The Husband and Wife hereby represent that they have each made full disclosure to the other party of their individual assets. Each party represents that s/he has provided the other with a current financial statement on the form promulgated pursuant to Supplemental Probate Court Rules, Rule 401, which discloses fully and completely all of her/his income, expenses, assets and liabilities. By executing this Separation Agreement, the parties represent that the terms and provisions of this agreement are fair, just and reasonable and are not the product of fraud, coercion or undue influence, and that each signs this agreement freely and voluntarily.Separation Agreement - Page Eight Commonwealth of Massachusetts Worcester 8S. Date: / | 3 / / a2 Then personally appeared the above-named Patricia Diane Galvan ,and acknowledged that - € - she - signed this separation agreement as - Big - her - free act and deed. Lh he dn. Notary Public - My Commission Expires: Laos Heidi E. Deluco NOTARY PUBLIC