Declaration of Domestic Partnership

I. Introduction

We, [YOUR FULL NAME] and [PARTNER'S FULL NAME], residing at [YOUR ADDRESS] and [PARTNER'S ADDRESS] respectively, hereby declare our intention and acknowledgement of being in a domestic partnership. This declaration affirms our commitment to each other and recognizes our mutual responsibility as partners.

II. Declaration Statement

I, [YOUR FULL NAME], and I, [PARTNER'S FULL NAME], certify that we meet the following criteria indicative of a domestic partnership:

• We are each eighteen years of age or older.

• We share a committed, intimate relationship responsible for each other's common welfare.

• We are not married to anyone else, nor are we a part of another domestic partnership.

• We are not related by blood closer than would bar marriage in the state of [YOUR STATE].

• We reside together and intend to do so indefinitely.

• We agree to inform [YOUR COMPANY NAME] if any circumstances change that could affect our domestic partnership status.

III. Acknowledgment of Terms

We understand that this declaration and any benefits derived herein are subject to the policies and procedures of [YOUR COMPANY NAME], located at [YOUR COMPANY ADDRESS]. We agree to provide truthful information to the organization regarding our partnership and to notify the company of any changes in our partnership status.

IV. Legal Recognition and Benefits

Our domestic partnership is legally recognized in [JURISDICTION], entitling us to certain rights and benefits afforded to domestic partners under the law, including:

[Specify legal rights and benefits applicable to domestic partnerships in your jurisdiction]

V. Commitment to Each Other

We pledge to uphold the commitments and promises made to each other, to cherish and support one another through all circumstances, and to work together to build a happy and fulfilling life as domestic partners.

VI. Affirmation of Partnership

We have read the terms and conditions set forth by [YOUR COMPANY NAME] concerning domestic partnerships. By signing below, we pledge that the information provided here is accurate and complete to the best of our knowledge. We understand that any misrepresentation may lead to disciplinary action including termination of employment and revoking of any benefits.

[YOUR FULL NAME]

[PARTNER'S FULL NAME]

[YOUR COMPANY NAME]

[DATE]

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