The Maryland Domestic Partnership form serves as an official declaration for couples wishing to establish their domestic partnership for benefits purposes. This affidavit affirms the relationship between the employee or retiree and their domestic partner, outlining criteria such as age, mutual support, and shared residence. Completing this form is essential for accessing health benefits and ensuring proper coverage for dependents.
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The Maryland Domestic Partnership form serves as a crucial document for individuals seeking to establish and formalize their domestic partnerships. This form includes an Affidavit for Domestic Partnership, which must be filled out by both the employee or retiree and their domestic partner. It requires the couple to certify their relationship status, confirming that they meet specific criteria, such as being at least 18 years old, not being related by blood or marriage within four degrees, and not being involved in other marital or partnership commitments. Additionally, the form emphasizes the importance of financial interdependence, requiring documentation like joint ownership of property or shared financial accounts. The couple must also demonstrate that they share a common primary residence. For those wishing to add dependents of their domestic partner, a separate section of the form outlines the eligibility requirements and necessary documentation, such as birth certificates and proof of residency. Furthermore, the form addresses tax implications, allowing for potential tax-favored treatment for qualifying dependents. By signing this affidavit, both parties affirm the accuracy of their statements, acknowledging the legal consequences of providing false information. Overall, the Maryland Domestic Partnership form is essential for ensuring that couples can access benefits and protections associated with their committed relationships.
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Affidavit for Domestic Partnership and Domestic Partner’s Dependents
This Affidavit must be completed if you are adding coverage for a Domestic Partner or Dependent Child of a Domestic Partner
Domestic Partnership:
I, _________________________________ and
________________________________________,
(Employee/Retiree)
(Domestic Partner)
certify that we are Domestic Partners (as defined in the benefits guide) and that we:
(1)Are each at least 18 years old;
(2)Are not related to each other by blood or marriage within four degrees of consanguinity under civil law rule;
(3)Are not married, in a civil union, or in a domestic partnership with another individual;
(4)Have been in a committed relationship of mutual interdependence for at least 12 consecutive months in which each individual contributes to some extent to the other individual’s maintenance and support with the intention of remaining in the relationship indefinitely;
Financial Interdependence is established by providing one of following dated documents:
(a)Joint ownership or lease of a motor vehicle
(b)Joint lease, mortgage or deed of your primary residence
(c)Joint checking, savings, investment, or credit account
(d)Designation as the primary beneficiary for life insurance, retirement benefits or the domestic partner’s will
(e)Mutual assignments of valid durable powers of attorney under Estates and Trusts Article, §13-601, Annotated Code of Maryland
(f)Mutual valid written advanced directives under Health-General Article, §5-601 et seq., Annotated Code of Maryland, approving the domestic partner as health care agent.
(5)Share our common primary residence.
Common Primary Residence is established by providing one of the following documents:
(a)Joint lease, mortgage or deed of your primary residence
(b)Copies of individuals’ driver’s license, State-issued identification card or voter’s registration card listing common primary address
(c)Utility or other household bill with both the name of the insured and the domestic partner appearing.
Tax Affidavit for Domestic Partner:
In some cases, your Domestic Partner may qualify as an eligible tax dependent. If he/she meets all three criteria below, the coverage attributable to your domestic partner may be eligible for tax-favored treatment. Please initial each description that applies to your Domestic Partner only if all three apply AND include a copy of your most recent income tax filing (with salary information blacked out).
Initials
Tax Dependent Criteria:
The Dependent is a person who is not my lawful spouse who lives with me and is a member of my household
for the entire year.
I provide over half of the Dependent’s support for the calendar year(s) in which coverage is provided.
The Dependent is not my or anyone else’s qualifying child for the tax year(s) in which coverage is provided.
We solemnly affirm under the penalties of perjury under applicable state laws, that the foregoing is true and accurate. We understand that willful falsification of information contained in this Affidavit can result in referral of the matter for investigation and prosecution, the termination of enrollment and coverage of the domestic partner, and the termination of coverage for the employee/retiree. We understand that a civil action may be brought against us for any losses, including reasonable attorney fees, because of a false statement contained in this affidavit. In addition, where permissible, employment related action may be taken against an active employee.
We agree to promptly notify the Department of Budget and Management, Employee Benefits Division upon any changes or circumstances attested to in this affidavit. We understand that we may not file another affidavit until at least one (1) year after termination of this domestic partnership.
_________________________________________ __________________________
_________________________
Signature of Employee/Retiree
Social Security Number
Date
_____________________________________ ________________________
Signature of Domestic Partner
Dependent Tax Affidavit for Domestic Partner’s Dependents:
Name of Employee/Retiree: ________________________________ Social Security Number: __________________________
Name of Domestic Partner’s Dependent: _____________________________________________________________________
Dependent’s Date of Birth: ______________________Social Security Number: ______________________________________
Part A: Dependent Relationship, Marital Status, and Age/Capability Requirements
A. Initial the box for the correct dependent relationship for your domestic partner’s dependent listed above. If none apply, this person is NOT eligible to be added to your health benefits coverage.
Dependent Relationship
Required Documentation
Biological Child of Domestic Partner
- Copy of Child’s Official State Birth Certificate
Adopted Child or child placed with domestic partner for adoption
- Copy of Adoption papers indicating child’s date of birth
by the Domestic Partner
- For pending adoptions – see Benefits Guide
Step-Child of Domestic Partner
- Copy of domestic partner’s Official State Marriage Certificate from
previous marriage
Grandchild of Domestic Partner
- Copy of Child’s Parent’s Official State Birth Certificate (to show
relationship to domestic partner)
Legal Ward of Domestic Partner (permanently resides with my
domestic partner and my domestic partner is his/her testamentary
- Proof of Residency (Valid Driver’s License, or State-issued
or court appointed
guardian for a non-temporary guardianship of
Identification Card, school records or day care records certifying
not less than 12 months.)
dependent’s address, Tax Documents listing child’s name certifying
address.)
- Copy of Legal Ward/Testamentary Court
Document, signed by a Judge.
Other Child Relative (includes step-grandchildren) of Domestic
Partner - dependent is related to my domestic partner by blood,
permanently resides with my domestic partner, and my domestic
partner provides his/her sole support.
- Signature of Sole Support Affirmation (see below)
B. Initial the box below, if the Dependent is NOT married. If this person is married, he/she is NOT eligible for State employee/retiree health benefits coverage.
The Dependent is NOT married
C. Initial the box by the statement that describes the Dependent. If neither statement accurately describes this Dependent, this person is not eligible for State employee/retiree health benefits coverage.
The Dependent is under the age of 25.
The Dependent is any age and is incapable of self-support because of a mental or physical incapability incurred before reaching age 25 and is chiefly dependent on me and/or my domestic partner for support.
Sole Support Affirmation for Other Child Relative Dependent ONLY:
I certify by my signature below that the dependent child listed on this form is supported solely by me and/or my domestic partner.
___________________________________________
_____________________
Domestic Partner’s Signature
Part B: Tax Criteria:
In some cases, the dependent of your Domestic Partner may qualify as your eligible tax dependent. If he/she meets all four criteria for the Qualifying Child Test or all three criteria for the Qualifying Relative Test on the following page the coverage attributable to your domestic partner’s dependent may be eligible for tax-favored treatment. If you cannot initial all four Qualifying Child or all three Qualifying Relative criteria, this person is NOT an eligible tax dependent and the portion of your coverage attributable to this dependent is not eligible for tax-favored status.
Qualifying Child Test Criteria – must meet all four criteria
The child is my biological child or adopted child (or placed for adoption by me), my legal ward or child placed with me
under court order (not temporary for less then 12 months), sibling, or descendent of my child or sibling (i.e. grandchild,
niece, nephew, etc); and
The child lives with me for more than half of the year (more than six months) or is my biological or adopted child and meets the following residence exceptions:
-The child received over half of the child’s support during the calendar year from the child’s parents, who (1) are divorced or legally separated under a decree of divorce or separate maintenance, or (2) are separated under a written separation agreement, or (3) live apart at all times during the last six months of the calendar year; and
-The child is in the custody of one or both of the child’s parents for more than half of the calendar year; and
-
The Child (1) has not attained age 19 as of the close of the calendar year(s) in which coverage is provided, or (2) is a full- time student for at least five months of the calendar year who has not attained age 24 as of the end of the calendar year(s) in which coverage is provided, or (3) is permanently and totally disabled; and
The child has not provided more than half of the child’s own support for the calendar year(s) in which coverage is provided.
-OR-
Qualifying Relative Test Criteria – must meet all three criteria
The Dependent has a specified relationship to me: my biological child, my adopted child (or placed for adoption by me),
my step-child, my grandchild, my niece, my nephew, my sibling, or a person who is not my lawful spouse who lives with
me and is a member of my household for the entire year (this includes a legal ward); and
I provide over half of the Dependent's support for the calendar year(s) in which coverage is provided; and
The Dependent is not my or anyone else's qualifying child for the tax year(s) in which coverage is provided. If this child meets
criteria for the Qualifying Child Test, this statement is not true.
We solemnly affirm under the penalties of perjury under applicable state laws, that the foregoing is true and accurate.
We understand that willful falsification of information contained in this Affidavit will result in our termination of enrollment. We understand that a civil action may be brought against us for any losses, including reasonable attorney fees, because of a false statement contained in this affidavit.
_________________________________________
Rev 9/1/09
Misconceptions about the Maryland Domestic Partnership form can lead to confusion and misunderstandings. Below is a list of ten common misconceptions, along with clarifications for each.
Understanding these misconceptions can help individuals navigate the Maryland Domestic Partnership process more effectively.
Completing the Maryland Domestic Partnership form can be a straightforward process, but several common mistakes can lead to complications or delays. One of the primary errors is failing to provide accurate personal information. Each party must ensure that names, Social Security numbers, and dates are entered correctly. Any discrepancies can result in the form being returned for correction, delaying the benefits that the couple is seeking.
Another frequent oversight involves not meeting the eligibility criteria. The form requires both partners to certify that they meet specific conditions, such as being at least 18 years old and not being related by blood or marriage within four degrees. If either partner does not satisfy these requirements, the application will be invalid, and benefits cannot be granted.
Many individuals also neglect to provide the necessary documentation to establish financial interdependence. The form lists several acceptable documents, such as joint leases or bank accounts. Failing to include this documentation can lead to questions about the legitimacy of the partnership and may result in denial of benefits.
Another critical mistake is not initialing the appropriate boxes in the Tax Affidavit section. If the Domestic Partner does not meet all three tax-dependent criteria, the coverage cannot qualify for tax-favored treatment. This section must be completed with care, as any errors or omissions can have financial implications.
Additionally, some applicants forget to sign and date the form. Both the Employee/Retiree and the Domestic Partner must provide their signatures. Without these signatures, the form is considered incomplete and will not be processed.
It is also essential to remember that the form cannot be filed again for at least one year after the termination of a domestic partnership. Couples often overlook this stipulation, which can lead to confusion if they attempt to reapply prematurely.
Lastly, many applicants fail to notify the Department of Budget and Management of any changes in circumstances. This oversight can lead to complications in coverage and potential legal issues if the information provided in the affidavit becomes outdated. Keeping the department informed is crucial for maintaining eligibility and ensuring that benefits continue without interruption.
Here are some key takeaways for filling out and using the Maryland Domestic Partnership form:
The Maryland Domestic Partnership form is essential for couples seeking to establish their partnership legally. Along with this form, several other documents may be required to ensure proper coverage and compliance with state regulations. Below is a list of commonly used forms associated with the Maryland Domestic Partnership.
Each of these documents plays a critical role in supporting the Maryland Domestic Partnership form. Ensure that you have all necessary paperwork completed and submitted to facilitate a smooth partnership registration process.
The Maryland Domestic Partnership form shares similarities with the Affidavit of Common Law Marriage. Both documents require individuals to attest to the existence of a committed relationship. In the case of common law marriage, partners must demonstrate mutual consent to be recognized as married without a formal ceremony. Similarly, the Maryland Domestic Partnership form mandates that partners declare their commitment to one another and outline shared responsibilities, such as financial support and cohabitation. Both documents emphasize the importance of mutual interdependence and shared living arrangements.
Another comparable document is the Cohabitation Agreement. This legal agreement is often used by unmarried couples living together to outline their rights and responsibilities. Like the Maryland Domestic Partnership form, a Cohabitation Agreement addresses financial interdependence and shared living situations. Both documents serve to protect the interests of each partner and clarify expectations within the relationship, providing a framework for resolving disputes should they arise.
The Affidavit of Support, commonly used in immigration cases, also bears resemblance to the Maryland Domestic Partnership form. This affidavit demonstrates a sponsor's commitment to financially support an immigrant. In both instances, the parties must provide evidence of their relationship and financial interdependence. The Maryland Domestic Partnership form requires documentation of shared finances and living arrangements, similar to how the Affidavit of Support necessitates proof of the sponsor’s financial capability to support the immigrant.
The IRS Form 8332, which allows for the release of a claim to exemption for a child of divorced or separated parents, is another related document. This form establishes financial responsibility for a dependent child, similar to the Maryland Domestic Partnership form's requirement for dependents of domestic partners. Both documents ensure that the financial obligations towards dependents are clear and legally recognized, which can have significant tax implications.
The Health Insurance Portability and Accountability Act (HIPAA) Authorization form is also comparable. This form allows individuals to designate someone to make health care decisions on their behalf. The Maryland Domestic Partnership form includes provisions for mutual durable powers of attorney and health care directives, ensuring that partners can make medical decisions for each other. Both documents highlight the importance of trust and shared responsibility in health care matters.
Additionally, the Declaration of Domestic Partnership serves a similar purpose. This document is often used in jurisdictions that recognize domestic partnerships, allowing couples to register their relationship officially. Like the Maryland Domestic Partnership form, it requires partners to affirm their commitment and may involve similar eligibility criteria, such as cohabitation and financial interdependence.
The Last Will and Testament can also be likened to the Maryland Domestic Partnership form. Both documents address the distribution of assets and responsibilities in the event of a partner’s death. While the Domestic Partnership form establishes a legal recognition of the relationship during the partner's lifetime, a will ensures that the partner's wishes regarding asset distribution are honored after death, further solidifying the commitment between partners.
The Texas RV Bill of Sale form is an essential document that facilitates the sale of a recreational vehicle, ensuring that both parties have a clear record of the transaction. Similar to various legal forms used to formalize relationships and responsibilities, this form serves to protect both buyer and seller by documenting key details such as the vehicle's identification and sale price. For individuals interested in completing this essential paperwork, the form is available here, making the process straightforward and accessible.
Lastly, the Power of Attorney document shares similarities with the Maryland Domestic Partnership form. A Power of Attorney grants one individual the authority to make legal decisions on behalf of another. This is particularly relevant in domestic partnerships, where partners may wish to designate each other as decision-makers in financial or medical matters. Both documents underscore the importance of mutual trust and the need for clear legal documentation in relationships.