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C-1. Declaration for Registration Systems
Declaration of Domestic Partnership
We declare under penalty of perjury:
- We have an intimate, committed relationship of mutual caring;
- We live together (see definition below);
- We agree to be responsible for each other's basic living expenses (see definition below) during our domestic partnership; we also agree that anyone who is owed these expenses can collect from either of us;
- We are both 18 or older;
- Neither of us is married and neither of us is related to the other as a parent, brother or sister, half brother or sister, niece, nephew, aunt, uncle, grandparent or grandchild;
- Neither of us has a different domestic partner now and neither of us has had a different domestic partner in the last six months (this last condition does not apply if you had a partner who died; if you did, cross this out).
We declare under penalty of perjury under the laws of the State of [insert name of state; some states do not use declarations under penalty of perjury for sworn statements; use whatever form your state uses for sworn statements] that the statements above are true and correct.
Signed on
in
Signature
Print Name
Signed on
in
Signature
Print Name
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Appendix B
1. Definitions
"Live together" means that the two of you share a place to live. You don't both have to be on the rental agreement or deed. It is okay if one or both of you has a separate place somewhere else. Even if one of you leaves the place you share, you still live together as long as the one who left intends to return.
"Basic living expenses" means the cost of basic food and shelter. It also includes any other expense which is paid by a benefit you or your partner gets because of the partnership. For example, if you get health insurance from your job, and the insurance covers your partner, you will be responsible for medical bills which the insurance does not pay. You don't have to split basic living expenses to be domestic partners. You just have to agree to provide these things for your partner if he or she can't provide for him or herself.
2. Address: Each of you should fill in your mailing address here:
Name
Address
City
State & Zip Code
Name
Address
City
State & Zip Code
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___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
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3. The Last Step: To finish setting up a domestic partnership,
you must EITHER:
- File this form with the [name of city or county] Clerk; or
- Sign this form in front of a Notary Public and have the Notary fill in the notarization at the bottom of this page.
[If your registration system will allow people the option of creating domestic partnerships by signing notarized statements instead of filing with the city or county, you should include whatever form notaries use in your state on the declaration form].
C-2. Declaration for Internal Systems
Declaration of Domestic Partnership
We declare under penalty of perjury:
- We live together (see definition on the other side of this page);
- We agree to be responsible for each other's basic living expenses (see definition on the other side of this page) during our domestic partnership; we also agree that anyone who is owed these expenses can collect from either of us;
- We are both 18 or older;
- Neither of us is married and neither of us is related to the other as a parent, brother or sister, half brother or sister, niece, nephew, aunt, uncle, grandparent or grandchild;
- Neither of us has a different domestic partner now and neither of us has had a different domestic partner in the last six months (this last condition does not apply if you had a partner who died; if you did, cross this out).
- We have been domestic partners since_________________ and we made the agreement described in paragraph 2 on _________________.
We declare under penalty of perjury under the laws of the State of [insert name of state; some states do not use declarations under penalty of perjury for sworn statements; use whatever form your state uses for sworn statements] that the statements above are true and correct.
Signed on
in
Signature
Print Name
Signed on
in
Signature
Print Name
|
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
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1. Definitions
"Live together" means that the two of you share a place to live. You don't both have to be on the rental agreement or deed. It is okay if one or both of you has a separate place somewhere else. Even if one of you leaves the place you share, you still live together as long as the one who left intends to return.
"Basic living expenses" means the cost of basic food and shelter. It also includes any other expense which is paid by a benefit you or your partner gets because of the partnership. For example, if you get health insurance from your job, and the insurance covers your partner, you will be responsible for medical bills which the insurance does not pay. You don't have to split basic living expenses to be domestic partners. You just have to agree to provide these things for your partner if he or she can't provide for him or herself.
2. Address: Each of you should fill in your mailing address here:
Name
Address
City
State & Zip Code
Name
Address
City
State & Zip Code
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___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
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