FILE NO: ___________________
This Space For Filing Use Only
State of California
Secretary of State
Declaration of Domestic Partnership
IMPORTANT – Read instructions before completing this form.
We the undersigned, do declare that we meet the requirem
ents of Family Code section 297, which are as follows:
Neither person is married to someone else or is a member of another domestic partnersh
ip with someone else that
has not been terminated, dissolved, or adjudged a nullity.
The two persons are not related by blood in a way that w
ould prevent them from being married to each other in this
state.
Both persons are at least 18 years of age, OR if one or both persons are under 18 years of
age, a certified copy of
the court order(s) granting permission to the underage person(s) to establish a domestic partnership is attached.
Both persons are members of the same sex, OR one or both of the persons is ov
er 62 years of age and one or both
meet the eligibility criteria under Title II of the Social Security Act as defined in United States Code, title 42, section
402(a) for old-age insurance benefits or Title XVI of the Social Security Act as defined in United States Code, title 42,
section 1381 for aged individuals.
Both persons are capable of cons
enting to the domestic partnership.
Both persons consent to the jurisdiction of the Superior
Courts of California for the purpose of a proceeding to obtain
a judgment of dissolution or nullity of the domestic partnership or for legal separation of partners in the domestic
partnership, or for any other proceeding related
to the partners' rights and obligations,
even if one or both partners
ceases to be a resident of, or to maintain a domicile in, this state.
The representations are true and correct, and contain no material omissions of fact to the best
of our knowledge and belief.
Filing an intentionally and materially false Declaration of Domestic Partnership shall be punishable as a misdemeanor.
(Family Code section 298(c).)
PARTNER 2
_
__________________________________________________________
Printed Name (Last) (First) (Middle)
_____________________________________________
_
_____________
Signature of Partner as Stated Above
OPTIONAL Name Changes:
New Last Name_____________________________________
New Middle Name ___________________________________
Date of Birth (required for name change)
_________________
PARTNER 1
___________________________________________________________
Printed Name (Last) (First) (Middle)
___________________________________________________________
Signature of Partner as Stated Above
OPTIONAL Name Changes:
New Last Name______________________________________
New Middle Name ____________________________________
Date of Birth (required for name change) __________________
Mailing Address City State Zip
SEC/STATE NP/SF DP-1 (Rev 04/2015)
(Page 1 of 2)
ACKNOWLEDGMENT
State of California
County of _____________________________)
On _________________________ before me, _________________________________________
(insert name and title of the officer)
personally appeared ______________________________________________________________,
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
Signature ______________________________ (Seal)
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
SEC/STATE NP/SF DP-1 (Rev 04/2015)
(Page 2 of 2)
Instructions for Completing the
Declaration of Domestic Partnership (Form NP/SF DP-1)
For easier completion, this form is available on the Secretary of State’s website at www.sos.ca.gov/registries/domestic-
partners-registry/. It can be viewed, filled in and printed from your computer. If you do not complete this form online,
please type or legibly print in black or blue ink. Do not alter this form.
Statutory filing provisions are found in California Family Code sections 297 and 298. All statutory references are to the
California Family Code, unless otherwise stated.
Complete the Declaration of Domestic Partnership (Form NP/SF DP-1) as follows:
Both persons must meet all of the requirements of Section 297, as stated on the front of the
Declaration
of Domes
tic Partnersh
ip form.
Both persons must sign and affix their signatures to the same Declaration of Domestic Partnership form.
Both persons must print their names legibly. T
he names must be printed in the order requested: Last
name, First name, Middle name. If there is a suffix, i.e.
Jr., Sr., etc., include this
as part of the last name.
One or both persons to a registered domestic partnership may change the middle or last names
by
which that person wishes to be known after registration of the domestic partnership by entering the new
name and including their date of birth in the spaces provided on the Declaration of Domestic Partnership
form. A person may adopt any of
the following middle or
last names: the current last name of the other
domestic partner; the last name of either domestic partner given at birth; a name combining into a single
last name all or a segment of the cu
rrent last name or the last name of
either domestic partner given at
birth; or a hyphenated combination of last names. (Section 298.6.)
A complete mailing address is required (address, city, state, zip code.)
Print legibly. Do not abbreviate
city names.
The signature of both persons must be notarized with
a certificate of acknowledgment. The Declaration
of
Domestic Partnership must be signed using the nam
e of the individual prior to the name change, if
any, lis
ted on this
form.
The completed form can be mailed to Secretary of State, Domestic Partners Registry, P.O. Box 942870, Sac
ramento,
CA 94277-2870 or delivered in person to the Sacramento office, 1500 11
th
Street, 2
nd
Floor, Sacramento, CA 95814
OR can be hand delivered for over-the-counter processing to the Los Angeles regional office. Please refer to the
Secretary of State’s website at www.sos.ca.gov/registries/domestic-partners-registry/ for office locations and
phone numbers.
FEES:
The fee for filing Form NP/SF DP-1 is $10.00.
For same-sex partners, an additional $23.00 fee must be paid at the time
of filing the form, for a total
of $33.00.
There is an additional $15.00 special handling fee for processing a document delivered in person to
the Sacramento office or to the Los Angeles regional office.
Payments for documents submitted:
by mail to Sacramento can be made by check or money order.
over-the-counter in Sacramento can be made by check, money order, cash, or credit card (Visa or
MasterCard).
over-the-counter in the Los Angeles regional office can be made
by check, money order, or credit card
(Visa or MasterCard). The Los Angeles regional office is not able to accept cash.
Checks or money orders should be made payable to the Secretary of State.
The
additional $23.00 fee will be used to develop and support a training curriculum specific to lesbian, gay, bisexual, and
transgender domestic abuse support service providers who serve that community in regard to domestic violence, and to
provide brochures specific to lesbian, gay, bisexual, and transgender domestic abuse. Brochures developed by the State
Department of Public Health will be available upon request from the Secretary of State, as funding allows.
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