Form Np/sf Dp-1a - Confidential Declaration Of Domestic Partnership Page 3
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1
2
3Instructions for Completing the
Confidential Declaration of Domestic Partnership (Form NP/SF DP-1A)
For easier completion, this form is available on the Secretary of State’s website at
partners-registry/. It can be viewed, filled in and printed from your computer. If you do not complete this form online,
please type or legibly print in black or blue ink. Do not alter this form.
Statutory filing provisions are found in California Family Code sections 297 and 298. All statutory references are to the
California Family Code, unless otherwise stated.
Complete the Confidential Declaration of Domestic Partnership (Form NP/SF DP-1A) as follows:
Both persons must be living together as domestic partners and meet all of the requirements of Section
297, as stated on the front of the Confidential Declaration of Domestic Partnership form.
Both persons must sign and affix their signatures to the same Confidential Declaration of Domestic
Partnership form.
Both persons must print their names legibly. The names must be printed in the order requested: Last
name, First name, Middle name. If there is a suffix, i.e. Jr., Sr., etc., include this as part of the last name.
One or both persons to a registered domestic partnership may change the middle or last names by
which that person wishes to be known after registration of the domestic partnership by entering the new
name and including their date of birth in the spaces provided on the Confidential Declaration of Domestic
Partnership form. A person may adopt any of the following middle or last names: the current last name
of the other domestic partner; the last name of either domestic partner given at birth; a name combining
into a single last name all or a segment of the current last name or the last name of either domestic
partner given at birth; or a hyphenated combination of last names. (Section 298.6.)
A complete mailing address is required (address, city, state, zip code.) Print legibly. Do not abbreviate
city names.
The signature of both persons must be notarized with a certificate of acknowledgment. The Confidential
Declaration of Domestic Partnership must be signed using the name of the individual prior to the name
change, if any, listed on this form.
The completed form can be mailed to Secretary of State, Domestic Partners Registry, P.O. Box 942870, Sacramento,
th
nd
CA 94277-2870 or delivered in person to the Sacramento office, 1500 11
Street, 2
Floor, Sacramento, CA 95814
OR can be hand delivered for over-the-counter processing to the Los Angeles regional office. Please refer to the
Secretary of State’s website at
partners-registry/
for office locations and
phone numbers.
FEES:
The fee for filing Form NP/SF DP-1A is $10.00.
For same-sex partners, an additional $23.00 fee must be paid at the time of filing the form, for a total
of $33.00.
There is an additional $15.00 special handling fee for processing a document delivered in person to
the Sacramento office or to the Los Angeles regional office.
Payments for documents submitted:
by mail to Sacramento can be made by check or money order.
over-the-counter in Sacramento can be made by check, money order, cash, or credit card (Visa or
MasterCard).
over-the-counter in the Los Angeles regional office can be made by check, money order, or credit card
(Visa or MasterCard). The Los Angeles regional office is not able to accept cash.
Checks or money orders should be made payable to the Secretary of State.
The additional $23.00 fee will be used to develop and support a training curriculum specific to lesbian, gay, bisexual, and
transgender domestic abuse support service providers who serve that community in regard to domestic violence, and to
provide brochures specific to lesbian, gay, bisexual, and transgender domestic abuse. Brochures developed by the State
Department of Public Health will be available upon request from the Secretary of State, as funding allows.
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