Affidavit Of Domestic Partnership Registration

Westchester County Clerk Leo nard N. Spano Information Through Technology Affidavit of Domestic Partnership Registration We, the under signed, and , do hereby declare ourselves to be domestic partners. We reside in the County of Westchester, or one of us is employed by the County of Westchester. We are both eighteen (18) years of age or older, unmarried and competent to enter into a contract. We are not related by blood in a manner that would bar marriage under the laws of the State of New York. We share a common household. We are in a close, committed, financially interdependent personal relationship and intend to remain in the relationship. We are each others sole domestic partner, have no other domestic partner and intend to remain each others sole domestic partner. Neither of us has terminated another domestic partnership within the last sixty (60) calendar days. We agree to file a termination statement in the event that the domestic partnership is terminated. S ignature Department (if emplyed by Westchester County) S ignature D epar tment (if employed by Westchester County) Address For Office Use Only Sworn to before me this day of , 20 Not ar y Public Registration Number D ate F iled The certificate will be issued solely upon the sworn statement of the applicants, under penalty of perjury, with no liability for the validity of the partnership assumed by the County of Westchester or the County Clerk, in accordance with Chapter 550 of the Laws of Westchester County. American LegalNet, Inc. www.USCourtForms.com