The Maryland Domestic Partnership form is a legal document that allows couples to formally recognize their committed relationship and access benefits typically reserved for married couples. By completing this affidavit, partners affirm their mutual interdependence, shared residence, and financial support, establishing eligibility for various benefits. If you are ready to take this important step, please fill out the form by clicking the button below.
The Maryland Domestic Partnership form serves as a vital document for couples seeking to establish their relationship in a legally recognized manner. This form is particularly important for employees and retirees who wish to add their domestic partners and their dependents to their health benefits coverage. To complete the Affidavit for Domestic Partnership, both partners must confirm their eligibility by meeting several criteria, including age, relationship status, and the nature of their commitment. Specifically, both individuals must be at least 18 years old, not related by blood or marriage within a specified degree, and must not be involved in another marriage or partnership. The form requires proof of financial interdependence, which can be demonstrated through various documents, such as joint ownership of property or shared financial accounts. Additionally, it emphasizes the importance of a shared primary residence, supported by relevant documentation. For those looking to add dependents, the form outlines specific criteria that must be met, such as the relationship to the domestic partner and the dependent's marital status. Furthermore, there are tax implications to consider, as the form includes a section that may allow for certain dependents to qualify as tax dependents under specific conditions. Overall, the Maryland Domestic Partnership form is designed to ensure that couples can navigate their benefits while affirming their commitment to one another.
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
After completing the Maryland Domestic Partnership form, it is important to submit it to the appropriate department for processing. Make sure to double-check all information for accuracy before sending it in.
The Maryland Domestic Partnership form is a legal document used to establish a domestic partnership between two individuals. It certifies that both parties meet specific criteria, such as age, relationship status, and financial interdependence. This form is necessary for individuals seeking health benefits coverage for their domestic partner or their partner's dependents.
To qualify as a Domestic Partner, both individuals must meet the following criteria:
Financial interdependence can be established by providing one of the following documents:
To add a dependent child of your Domestic Partner, you must complete the appropriate section of the form. You will need to provide documentation that verifies the child's relationship to the Domestic Partner, such as:
Additionally, you must affirm that the dependent is not married and meets age or capability requirements.
Your Domestic Partner may qualify as an eligible tax dependent if they meet specific criteria. These include living with you for the entire year and you providing over half of their support. If the dependent child meets the criteria for a qualifying child or qualifying relative, their coverage may also be eligible for tax-favored treatment.
Providing false information on the Maryland Domestic Partnership form can lead to serious consequences. This includes termination of enrollment and coverage for both the domestic partner and the employee/retiree. Legal action may also be pursued for any losses incurred due to false statements.
No, you cannot file another affidavit until at least one year after the termination of the domestic partnership. It is important to notify the Department of Budget and Management, Employee Benefits Division, of any changes in your circumstances.
Incomplete Information: Failing to fill in all required fields, such as names, signatures, or social security numbers, can lead to delays or denials.
Incorrect Age Verification: Not confirming that both partners are at least 18 years old can invalidate the application.
Misunderstanding Relationship Criteria: Not recognizing that partners must not be related by blood or marriage within four degrees can lead to disqualification.
Overlooking Financial Interdependence: Failing to provide appropriate documentation to prove financial interdependence, such as joint accounts or shared bills, is a common mistake.
Not Establishing Common Residence: Not providing proof of a shared primary residence, like a joint lease or utility bill, can result in rejection.
Ignoring Tax Dependent Criteria: Not initialing the tax dependent criteria correctly or misunderstanding the requirements can disqualify a partner.
Failing to Sign: Forgetting to sign the affidavit, either by the employee or the domestic partner, can halt the process.
Neglecting to Update Information: Not notifying the Department of Budget and Management about any changes in circumstances can lead to penalties.
Submitting Outdated Documents: Using expired or incorrect documents for proof of relationship or residency can cause issues with the application.
The Maryland Domestic Partnership form is an essential document for couples seeking to establish their partnership legally. However, several other forms and documents are commonly used alongside this form to ensure that all aspects of the partnership are recognized and protected. Below is a list of these documents, each serving a specific purpose in the process of formalizing a domestic partnership.
Each of these documents plays a vital role in the establishment and recognition of a domestic partnership in Maryland. By ensuring that all necessary forms are completed and submitted, partners can protect their rights and benefits, fostering a secure and legally recognized relationship.
The Maryland Domestic Partnership form shares similarities with the Affidavit of Support, commonly used in immigration cases. Both documents require individuals to affirm their commitment to a relationship, demonstrating financial interdependence and mutual support. Just as the Domestic Partnership form outlines criteria for establishing a committed relationship, the Affidavit of Support necessitates proof that the sponsor can support their immigrant partner financially, ensuring that both parties are invested in the partnership and can provide for one another.
Another document akin to the Maryland Domestic Partnership form is the Joint Tenancy Agreement. This legal instrument establishes shared ownership of property between two or more individuals, similar to how the Domestic Partnership form requires proof of shared residence. Both documents emphasize the importance of financial commitment and mutual support, highlighting the legal and financial ties that bind partners together.
The Health Care Proxy serves as another comparable document, as it allows individuals to designate someone to make medical decisions on their behalf if they become incapacitated. Just like the Domestic Partnership form, which can include mutual assignments of durable powers of attorney, the Health Care Proxy underscores the trust and reliance partners have on each other in critical situations. Both documents are essential for ensuring that partners' wishes are respected in health-related matters.
The Tax Affidavit for Domestic Partners is directly related to the Maryland Domestic Partnership form, as it establishes criteria for determining whether a domestic partner qualifies as a tax-dependent. Both documents require the completion of specific criteria to ensure that the relationship is genuine and financially intertwined. This connection is vital for tax purposes, allowing partners to benefit from tax-favored treatment, much like traditional family structures.
Finally, the Marriage Certificate is a well-known document that serves a similar purpose in validating a committed relationship. While the Domestic Partnership form is designed for couples who choose not to marry, both documents formalize a partnership and often provide similar legal rights and benefits. They both require proof of a committed relationship and may involve similar eligibility criteria, thereby establishing a legal foundation for the partners involved.
When filling out the Maryland Domestic Partnership form, it’s important to be careful and thorough. Here’s a list of things you should and shouldn’t do:
Understanding the Maryland Domestic Partnership form can be challenging, and several misconceptions often arise. Here are seven common misunderstandings:
Understanding these misconceptions can help individuals navigate the Maryland Domestic Partnership process more effectively. Always ensure that you are informed about the requirements and implications of the form.
When considering the Maryland Domestic Partnership form, it's essential to understand its requirements and implications. Here are some key takeaways:
Understanding these points can help ensure that the process of filling out and using the Maryland Domestic Partnership form goes smoothly and complies with the necessary legal requirements.