Affidavit Of Common Law Marriage Or Domestic Partnership

UCAR

AFFIDAVIT OF COMMON LAW MARRIAGE OR DOMESTIC PARTNERSHIP

SECTION I – COMMON LAW SPOUSE OR DOMESTIC PARTNER

CERTIFICATION

A. COMMON LAW SPOUSE

I, ______________________________________, certify that ________________________________ is my

common law spouse and that we:

Live together as husband and wife,

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Publicly claim to be husband and wife,

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Are generally understood to be husband and wife among neighbors, acquaintances and those

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with whom we are associated in our daily lives,

Are in an opposite gender relationship, and

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Meet the legal definition of a common law marriage under the laws of the State of Colorado.

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B. DOMESTIC PARTNER

I, ______________________________________, certify that _______________________________ is my

domestic partner and that we:

Are each 18 years of age or older,

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Are in a same-gender partnership,

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Share a close personal relationship and are responsible for each other’s common welfare,

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Have lived together continuously for six months,

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Are each other’s sole domestic partner,

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Are not married to anyone and have not had another domestic partner within the past 12

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months,

Are not related by blood closer than would bar marriage in the State of Colorado,

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Share the same regular and permanent residence, with the current intent to continue to do so

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indefinitely,

Are jointly financially responsible for “basic living expenses” defined as the cost of basic

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food, shelter, and any other expenses of a domestic partner which are paid at least in part by

a program or benefit for which the partner qualified because of the domestic partnership.

Domestic partners need not contribute equally or jointly to the cost of these expenses as long

as they agree that both are responsible for the cost, and

Were mentally competent to consent to contract when our domestic partnership began.

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SECTION II – TERMS AND CONDITIONS

As an employee eligible for coverage under the UCAR health care program, by signing this affidavit I

understand that:

My common law spouse or domestic partner is eligible as a dependent for enrollment in the

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health care program during open enrollment periods, at the time of my hire or within 30 days

of becoming a newly eligible dependent.

This affidavit will be terminated upon the death of my common law spouse or domestic

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partner, or by a change in circumstances attested to in this affidavit.

I must notify the human resources department, within 30 days, of any change in

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circumstances attested to in this affidavit by completing and submitting a Statement of

Termination of Domestic Partnership or legal documents for marriage dissolution.

Affidavit Of Common Law Marriage Or Domestic Partnership - Ucar

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