Affidavit of Domestic Partnership - California

California · Fillable PDF · Free

Sworn proof of a committed relationship for benefits or insurance. An employer, insurer or housing provider accepts a sworn statement about a committed relationship and shared household. This is not registration of a domestic partnership with the California Secretary of State.

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Who this form is for

• Partners documenting their relationship for an accepting organization.
• Couples arranging notarization of both partners' sworn statements.

What you'll need

• The organization's eligibility, form and supporting-proof requirements.
• Both partners' legal names, shared address and start date, and truthful shared-finance information.
• Requested proof and acceptable identification for both partners.

How to complete it

1. Ask the receiving organization whether it accepts this form and what supporting records it requires.
2. Complete the partner, household, shared-finance and registration statements truthfully. State registration uses the Secretary of State's separate form.
3. Save and check the PDF in your own PDF app, then print. Both partners sign under oath before the notary.
4. Submit the affidavit and requested proof, keep a copy and notify the organization if the partnership ends. Ask HR or a tax advisor about benefits-related tax consequences.

Related California forms

These forms are a free convenience, not legal advice. First Choice Mobile Notary & Apostille is not a law firm. Consult an attorney licensed in the relevant state for legal questions.

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