Other Names
- Domestic Partnership Affidavit
- Domestic Partnership Agreement
- Domestic Partnership Application
- Declaration of Domestic Partnership
Benefits
While regulation varies in each state, domestic partners may benefit from the following rights:
- Inheritance
- Property rights
- Healthcare benefits, hospital visitation, and medical decisions
- Tax and insurance benefits
- Parental rights
- Family leave
Legal Recognition By StateFull RecognitionDomestic partnerships (“civil unions” or “reciprocal beneficiary relationships”) provide many of the rights and benefits of a legal marriage in the following states:
*Colorado and Illinois domestic partnership applications must be submitted online through the appropriate county clerk’s office. Limited RecognitionThe states below recognize domestic partnerships in a limited capacity, such as only in certain jurisdictions or only for same-sex couples, city/government employees, or individuals 62 or older.
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General Requirements
Each city, county, and state may have its own laws regarding the requirements of signing a domestic partnership affidavit, but there are a number of conditions that are typical across the board.
- The parties must be at least 18 years of age.
- The parties must be mentally competent adults.
- The parties cannot already be in a domestic partnership, civil union, or marriage with each other or anyone else.
- The parties cannot be related by blood to a degree that would otherwise make marriage illegal.
- The parties are not being forced into the relationship.
- The parties have been living together for a certain period of time.
Sample
Download: PDF, Word (.docx), OpenDocument
AFFIDAVIT OF DOMESTIC PARTNERSHIP
County of [COUNTY]
State of [STATE]
1. THE PARTNERS. On [MM/DD/YYYY], this Domestic Partnership Affidavit (“Affidavit”) declares the following individuals to be considered in a domestic partnership:
Partner 1: [PARTNER 1 NAME]
Partner 2: [PARTNER 2 NAME]
Address: [PARTNERS’ ADDRESS OF RESIDENCE]
Partner 1 and Partner 2 shall be referred to collectively as the “Couple” and declare to be domestic partners in accordance with the following criteria:
2. DECLARATION. We, the Couple, affirm that this relationship began on or about [MM/DD/YYYY], and acknowledge the following to be true and correct:
a) We are both at least eighteen (18) years of age and mentally competent to consent.
b) We are not related by blood to a degree of closeness that would prohibit legal marriage in the State in which we legally reside.
c) We are each other’s sole domestic partner, and we intend to remain so indefinitely.
d) Neither of us is legally married or legally separated from anyone else, and neither of us has had another domestic partner within the past six (6) months.
e) We cohabit and reside together in the same residence and intend to do so indefinitely. We have resided in the same household for at least six (6) months or the legally required period.
f) We are not in this relationship solely for the purpose of obtaining benefits coverage.
g) We are engaged in a committed relationship of mutual caring and support and are jointly responsible for our common welfare and living expenses.
3. CHANGE IN DOMESTIC PARTNERSHIP. We, the Couple, agree to notify all parties offering benefits due to our domestic partnership status within thirty (30) days of any change or termination. In addition, if a domestic partnership is terminated, another may not be created for another six (6) months.
4. ACKNOWLEDGMENTS. We, the Couple, have provided the information located in this Affidavit for the sole purpose of determining our eligibility for domestic partner benefits within the state of [STATE]. We further understand that any false or misleading statements made in order to receive benefits for which we do not qualify may be subject to disciplinary action.
Partner 1 Signature: ______________________________ Date: _______________
Print Name: [PARTNER 1 NAME]
Partner 2 Signature: ______________________________ Date: _______________
Print Name: [PARTNER 2 NAME]
NOTARY ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. |
State of [STATE]
County of [COUNTY]
The foregoing instrument was acknowledged before me, [NOTARY PUBLIC NAME], on [MM/DD/YYYY], by the undersigned, [AFFIANT NAME], who is personally known to me or satisfactorily proven to me to be the person whose name is subscribed to the within instrument.
WITNESS my hand and official seal.
Signature: ________________________
(Seal)