are attesting to a common law marriage or domestic partnership. The Employee and the Domestic Partner/Spouse ... Texas. District of Columbia Kansas.
2 mai 2022 — We, the undersigned (hereinafter referred to as the “Employee” and the “Domestic Partner or. Common Law Spouse”), execute this notarized Affidavit of Common ...
AFFIDAVIT OF COMMON LAW MARRIAGE/DOMESTIC PARTNER STATUS
We, the undersigned (hereinafter referred to as the "Employee" and the "Domestic Partner or Common Law Spouse"), execute this notarized Affidavit of Common Law Marriage/Domestic Partner Status ("Affidavit") as of the date set forth below. The Employee and the Domestic Partner/Spouse, as applicable are executing this notarized Affidavit as part of the requirements for obtaining certain benefits provided by NXP USA, Inc. ("NXP").
Please make sure the form is completed in its entirety, including indicating whether or not you are attesting to a common law marriage or domestic partnership.
The Employee and the Domestic Partner/Spouse hereby certify as follows (check appropriate alternative One or Two certification below):
___ Alternative One (Common Law Marriage):
a. We became common law married while living in: (choose appropriate state)
___Alabama
___Idaho (prior to 1/1/1996) ___Ohio (prior to 10/10/1991) ___South Carolina
___Colorado
___Iowa
___Oklahoma (prior to 11/1/1998) ___Texas
___District of Columbia ___Kansas
___Pennsylvania (prior to 1/1/2005) ___Utah
___Georgia (prior to 1/1/1997) ___Montana
___Rhode Island
b. We are common law married in accordance with the following:
i. We live in the same household as husband and wife;
ii. We each consent to being married to the other, we have an actual and mutual agreement that we are married, and we intend that we actually are husband and wife; and
iii. We hold ourselves out as a married couple (typically this means some or all of the following: using the same last name, referring to the other as "my husband" or my wife," noting marital status as "married" on records/applications/documents, filing joint income tax returns, holding joint accounts and joint ownership of assets, engaging in a committed relationship of mutual caring and support, being jointly responsible for each other's common welfare and sharing financial obligations).
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c. We are each legally free to consent to marriage, including:
i. We are each at least 18 years of age;
ii. We are each mentally competent to consent to marriage;
iii. We are not related by blood to a degree of closeness that would prevent marriage under the laws of the state in which we reside; and
iv. Neither of us is currently married to another person (which means that any prior marriage, including common law, has been terminated by death or divorce).
___ Alternative Two (Domestic Partner):
a. We are both at least 18 years of age and capable of consenting to the relationship;
b. We are not related to one another to a degree that would prevent marriage under the laws of the state in which we reside;
c. Neither of us is legally married to another person under statutory or common law and neither of us is in another domestic partnership;
d. We are in a single, dedicated relationship with each other;
e. We have lived together in such a relationship for a period of not less than six consecutive months and have shared a single residence during such entire period; and
f. We have a dedicated relationship with each other that we intend to continue indefinitely.
The Employee and the Domestic Partner/Spouse certify that they have read and understand the foregoing Affidavit and that all information set forth in this Affidavit is true and correct.
Please make sure the form is completed in its entirety, including indicating whether or not you are attesting to a common law marriage or domestic partnership.
EMPLOYEE:
DOMESTIC PARTNER/SPOUSE:
_____________________________________ ______________________________________
Printed Name: __________________________ Printed Name: ____________________________
Date: _________________________________ Date: __________________________________
NOTARY PUBLIC:
Sworn to before me this ____ day of ______________, 20__.
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