Affidavit of Domestic Partnership
Affidavit of Domestic Partnership
Recipient: [EMPLOYER, BENEFITS ADMINISTRATOR, OR OTHER RECIPIENT]
Purpose of affidavit: [STATE WHY THE RECIPIENT REQUESTS IT]
Applicable plan, policy, or request number (if any): [NUMBER]
We, the undersigned, each being sworn, state from our personal knowledge:
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Partner One: My full legal name is [FULL NAME]. My mailing address is [ADDRESS].
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Partner Two: My full legal name is [FULL NAME]. My mailing address is [ADDRESS].
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We identify each other as domestic partners. Our relationship began on or about [__/__/____].
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Our current living arrangement is: [SHARED RESIDENCE AT ADDRESS / SEPARATE RESIDENCES, EXPLAIN IF RELEVANT: __________]. We have lived at a shared address, if any, since [__/__/____].
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For the purpose identified above, the following facts also apply. Complete only the facts that are true and relevant to the recipient's stated requirements:
- ☐ We share responsibility for these household expenses: [DESCRIBE].
- ☐ We hold these shared financial obligations or property interests: [DESCRIBE WITHOUT ACCOUNT NUMBERS].
- ☐ We have designated each other for these benefits, emergency contacts, or decision roles: [DESCRIBE].
- ☐ We are registered as domestic partners with [AGENCY / JURISDICTION]; registration date: [__/__/____]; registration or certificate number, if requested: [NUMBER].
- ☐ Other relevant facts: [DESCRIBE].
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The supporting records we are providing to the recipient, if requested, are: [LIST DOCUMENT TYPES ONLY].
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Each of us has read this affidavit and believes every completed statement to be true. We will notify [RECIPIENT] of a material change if its plan, policy, or request requires notice, using the procedure and timing stated there.
We make this affidavit solely for the purpose stated above. Any separate eligibility decision belongs to the recipient under its applicable requirements.
Partner One signature: ______________________________ Date: [__/__/____]
Printed name: [FULL NAME]
Partner Two signature: ______________________________ Date: [__/__/____]
Printed name: [FULL NAME]
Jurat
State or jurisdiction: [STATE / JURISDICTION]
County or locality: [COUNTY / LOCALITY]
Subscribed and sworn to (or affirmed) before me by [PARTNER ONE FULL NAME] and [PARTNER TWO FULL NAME] on [__/__/____].
Notarial officer signature: ______________________________
Printed name and title: [NAME AND TITLE]
Commission expiration (if applicable): [__/__/____]
Seal (if required): [SEAL]
About this template
- Last updated
- October 15, 2026
- Last reviewed
- October 15, 2026
- Jurisdiction
- All states
- Category
- Family Law
Family law covers the paperwork that shapes divorce, custody, child support, adoption, guardianship, and other family matters. These filings are emotional and high-stakes, and they also have to meet strict procedural rules for service, financial disclosure, and parenting plans. Clean, accurate paperwork keeps the focus on getting a workable outcome for the family instead of getting derailed by technical problems that delay hearings or force amended filings.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on October 15, 2026.
California Secretary of State, Declaration of Domestic Partnership (Form DP-1), instructions (checked October 15, 2026): "A domestic partnership shall be established in California when both persons file a Declaration of Domestic Partnership (Form DP-1) with the Secretary of State."
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