We the undersigned attest to the following:
- each party is the sole domestic partner of the other.
- each party is at least eighteen (18) years of age or older.
- both parties currently share a common legal residence and have shared said residence for at least the previous twelve (12) months.
- neither party is married, a party to a Civil Union, or related to the other by adoption or blood to a degree of closeness that would bar marriage/Civil Union in the state in which they legally reside.
- both parties are in a relationship of mutual support, welfare caring, and commitment and intend to remain in such a relationship in the indefinite future.
- the parties are jointly responsible for basic living expenses (basic living expenses are defined as the cost of basic food, shelter, and any other expenses of the common household; the partners need not contribute equally or jointly to the payment of these expenses as long as they agree that both are responsible for them); and
- We are both competent to enter in a legally binding contract
SWORN STATEMENT
We declare that all the foregoing information provided by us is true and correct and that all provisions of this Statement have been met.
We understand that:
- If there is any change in the information certified in the Statement of Domestic Partnership that would make the domestic partner ineligible, the employee must notify Human Resources immediately.
Declaration of Domestic Partner
We have read and understand the terms and conditions contained in this Statement of Domestic Partnership. We understand that any misrepresentation of fact can result in the loss of pass privileges immediately, and the employee could be disciplined up to and including termination for misrepresentation of domestic partnership.