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The employee agrees to notify the University in writing within thirty-one (31) days of any termination of our domestic partnership. ... We, the undersigned employee of the University of Maine System and the Domestic Partner, understand that falsification of information contained in this Affidavit may lead to disciplinary action,
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www.maine.edu/pdf/DPForm.pdf
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We have read and understand this Affidavit of Domestic Partnership, including the information on the back of this form. We understand that Wis. Stat. ... Certifying a domestic partnership through this affidavit does not create a domestic partnership under Wisconsin Statute Chapter 770, nor does it constitute a...
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etf.wi.gov/publications/et2371.pdf
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We agree to promptly notify the Department of Budget and Management, Employee Benefits Division upon any changes or circumstances attested to in this affidavit. We understand that we may not file another affidavit until at least one (1) year after termination of this domestic partnership.
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www.dbm.maryland.gov/employees/healthben/Documents/HBFo...
www.dbm.maryland.gov/employees/healthben/Documents/HBForms/affidavit_domestic_partnership_and_dependents.pdf
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AFFIDAVIT OF DOMESTIC PARTNERSHIP; I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT; THE STATEMENTS BELOW ARE TRUE AND CORRECT. 1. That the partnership between: and was declared on: full date (example: March 14, 2004);
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www.realcare.biz/RealtorFiles/1177901191_BC_DP_Affidavi...
www.realcare.biz/RealtorFiles/1177901191_BC_DP_Affidavit_.pdf
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For purposes of this affidavit, a "domestic partnership" is one consisting of two persons in which the following applies: 1. Both are at least 18 years of age; 2. Are responsible for each other's welfare and are each other's sole domestic partners;
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www.oregon.gov/DAS/OEBB/docs/OpenEnrollment/Domesticpar...
www.oregon.gov/DAS/OEBB/docs/OpenEnrollment/Domesticpartnershipaffidavit.pdf
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Affidavit of Domestic Partnership; (For Coverage Effective in 2009 Only); This form should only be used to apply for domestic partner coverage effective prior to January 1, 2010 for the following plans that currently offer domestic partner coverage: •;
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www.uwsa.edu/hr/benefits/ins/uws50.pdf
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At least six months have passed since the termination of any previous same-sex domestic partnership. ... This affidavit is requested for the purpose of Indiana University making a determination of our eligibility for domestic-partner benefits provided by Indiana University;
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www.indiana.edu/~uhrs/pubs/forms/affidavit.htm
www.indiana.edu/~uhrs/pubs/forms/affidavit.htm
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EXHIBIT A Procedure 07-06-08 C O N F I D E N T I A L THE UNIVERSITY OF PITTSBURGH AFFIDAVIT OF DOMESTIC PARTNERSHIP I, ,certify that: Faculty/Staff Member Name and Social Security Number (print) 1. and I reside together and Domestic Partner's Name and Social Security Number (print) intend to do so indefinitely at...
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www.pitt.edu/HOME/PP/forms/form0185.html
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Many domestic partnership registration or benefit plans, whether for government or private business, require participants to sign an affidavit declaring their relationship. Since there are ... Also see: Sample Domestic Partnership Affidavit I — a basic form; Sample Domestic Partnership Affidavit II — a complex form...
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www.buddybuddy.com/d-p-affi.html
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