CITY OF FLAGSTAFF
DECLARATION OF DOMESTIC PARTNERSHIP
AND
APPLICATION FOR DOMESTIC PARTNERSHIP REGISTRATION
We, the undersigned, under penalty of perjury, declare that we are in a relationship of mutual support, caring,
and commitment; that we mutually contribute to each other’s support and maintenance and are responsible for
each other’s welfare. We further affirm that we meet the criteria for domestic partnership registration as
follows:
1. We reside in the City of Flagstaff.
2. We share a common primary residence.
3. We are in a relationship of mutual support, caring and commitment with each other and share
responsibility for each other’s common welfare.
4. Neither of us is part of an existing domestic partnership, civil union, or marriage with any third
party.
5. We are 18 years of age or older; and competent to enter into a contract.
6. We are not related to one another by blood closer than would bar marriage in the State of Arizona.
STATE OF ARIZONA, )
: ss.
COUNTY OF COCONINO )
On this day of , , personally appeared ,
and who acknowledged to me that they executed the above
instrument.
Notary Public in and for said County and State
Date of Application:
ID Type Provided
Registry Fee Paid
Registry Number:
