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Declaration Of Domestic Partnership - Florida
| Declaration Of Domestic Partnership Form. This is a Florida form and can be used in General Palm Beach Local County . |
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Return to __________________ __________________ __________________ DECLARATION OF DOMESTIC PARTNERSHIP We swear or affirm under penalty of perjury that: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. We are residents of Palm Beach County; We are both at least eighteen (18) years old and competent to contract; We are not married to each other or anyone else; We are the sole domestic partner of the other person; We are not related to the other by blood; We consent to the domestic partnership relationship without force, duress or fraud; We agree to be jointly responsible for each other's basic food, shelter, common necessities of life and welfare; We have not been a member of another domestic partnership for the past year; We share our primary residence with each other; We consider ourselves to be a member of the immediate family of each other; We share financial responsibilities as domestic partners; and that The name and mailing addresses of each domestic partner are: Partner 1: Printed Name Address Partner 2: City, State, Zip Printed Name Address City, State, Zip dompar_declaration rev 9-23-2011.doc 1 American LegalNet, Inc. www.FormsWorkFlow.com Declaration of Domestic Partnership Page 2 The documentation as indicated below is provided with this declaration. Copies may be presented in lieu of originals. Documentation will be returned to you. Please check those items presented. To establish mutual residence, one (1) of the following must be presented. ___ Current mortgage, deed or lease showing both names ___ Current driver's licenses showing the same address for both partners ___ Current tax returns showing the same address for both partners ___ Current government issued photo identification showing the same address for both partners To establish joint financial responsibility, two (2) of the following must be presented. ___ Current mortgage, deed or lease showing both names ___ Current statement from joint bank account ___ Current credit card statement with same account number for both names ___ Vehicle title showing common ownership ___ A beneficiary designation form for a retirement plan or life insurance policy signed and completed to the effect that one domestic partner is the beneficiary of the other ___ Wills designating the other as primary beneficiary 2 American LegalNet, Inc. www.FormsWorkFlow.com Declaration of Domestic Partnership Page 3 Acknowledgment: I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for making a false statement includes fines and/or imprisonment. Dated: ____________________________________________________ Signature of Partner: Printed Name: Address: City, State, Zip: STATE OF FLORIDA COUNTY OF PALM BEACH Sworn or affirmed and signed before me on by ______________ __________ _____________ ____________________ Notary Public or Deputy Clerk of Court __________________________________ [Print, type or stamp commissioner name of notary or clerk] Deputy Clerk Signature and Seal 3 American LegalNet, Inc. www.FormsWorkFlow.com Declaration of Domestic Partnership Page 4 Acknowledgment: I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for making a false statement includes fines and/or imprisonment. Dated: ____________________________________________________ Signature of Partner: Printed Name: Address: City, State, Zip: STATE OF FLORIDA COUNTY OF PALM BEACH Sworn or affirmed and signed before me on by ______________ __________ _____________ ____________________ Notary Public or Deputy Clerk of Court __________________________________ [Print, type or stamp commissioner name of notary or clerk] Deputy Clerk Signature and Seal 4 American LegalNet, Inc. www.FormsWorkFlow.com
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