Affidavit of Marriiage or Domestic Partnership - Willamette University
Willamette University
Human Resources
AFFIDAVIT OF MARRIAGE OR DOMESTIC PARTNERSHIP
SECTION I - Certification of Marriage or Domestic Partnership
I, (name of undersigned Willamette University faculty or staff
member) certify that (please complete “A” or “B” or “C”):
A. Marriage
(name of spouse) and I were legally married on _____
(date)
in the State of ________________________________________ .
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B. Unregistered Domestic Partnership
(name of domestic partner) and I entered into an effective
domestic partnership as of ________ (date), as defined by Willamette University below:
• We share the same regular and permanent residence.
• We share an ongoing, personal and committed relationship which we have with no other and which is
comparable to marriage.
• We either are not legally permitted to marry or choose not to marry for ethical or other significant
personal reasons.
• We are jointly responsible for each other’s welfare and the maintenance of our household as
demonstrated by several of the following: a written domestic partnership agreement; a joint real
estate mortgage, lease or deed; current beneficiary designation naming the domestic partner as a
primary beneficiary of life insurance, retirement plan or a will; joint ownership of a motor vehicle; joint
checking and/or savings account; or a joint credit account.
• Neither of us is married to anyone else.
• Each of us is eighteen years of age or older.
• We are not related by blood closer than would bar marriage in the state of Oregon.
• We were mentally competent to consent to contract when our committed partnership began.
The fair market value of a benefit may be taxable. In addition, domestic partners, registered or
unregistered, may not be beneficiaries under Flexible Spending programs. Please consult with your tax
advisor before checking the appropriate box below:
I certify that the previously named person is my legal tax dependent under IRS Sec. 152.
OR
I certify that the previously named person is not my legal tax dependent under IRS Sec. 152.
Move to Section II
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