Affidavit of Common Law Marriiage - Kansas
Rev. 08/2005
AFFIDAVIT OF COMMON LAW MARRIAGE
You are requesting that we consider the common law spouse that you list below as a dependent
under a common law marriage relationship. The following questions must be answered and returned
to State Human Resources before your request can be reviewed.
Any person who knowingly and with intent to defraud or deceive the State of Kansas gives false,
incomplete or misleading information on this affidavit may be subject to any remedies available
under law.
I. The following questions are to be completed by the employee:
1. Your name Social Security Number ________________
2. Common Law Spouse’s name __________________________________________________
Common Law Spouse’s Social Security Number ___________________________________
3. Are you presented and known throughout your communi
4.
a. Indicate the date you entered into your common law marriage
(month/day/year)
b. If yes, in what state did you reside on that date?
5.
If you answered yes, please provide a copy of the auto registration or title, deed or property tax
statement.
6.
If your answer is yes, please provide a copy of your last income tax return.
7. Do you have joint checking and/or savings
If the answer is yes, please provide a copy of your financial statement.
8. Are there any factors which would prevent the two of you from marrying, including but not
limited to, a prior marriage of either party that has not been legally terminated by death or
divorce?
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