Fillable Affidavit Pursuant to Declaring Domestic Partner Relationship Declaring Domestic Partner Relationship Form DS-7669

Fill Online, Printable, Fillable, Blank Affidavit Pursuant to Declaring Domestic Partner Relationship Declaring Domestic Partner Relationship Form DS-7669 Form

Use Fill to complete blank online U.S. DEPARTMENT OF STATE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Affidavit Pursuant to Declaring Domestic Partner Relationship Declaring Domestic Partner Relationship Form DS-7669

On average this form takes 3 minutes to complete

The Affidavit Pursuant to Declaring Domestic Partner Relationship Declaring Domestic Partner Relationship Form DS-7669 form is 1 page long and contains:

  • 1 signature
  • 0 check-boxes
  • 6 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Department of State forms online.

The US Department of State (DOS) or the State Department, is the government official division that advises the President and performs international relations. Equivalent to the outside service of different nations, it was built up in 1789 as the country's first official department.

BROWSE U.S. DEPARTMENT OF STATE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
AFFIDAVIT PURSUANT TO DECLARING DOMESTIC PARTNER RELATIONSHIP
U.S. Department of State
DS-7669-Hardcopy
07-2017
For the purposes of obtaining benefits and assuming obligations under the Foreign Affairs Manual (FAM) and
Department of State Standardized Regulations (DSSR), I, ,
declare that I and :
Name of Employee
Full Name of Domestic Partner
(1) are each other's sole domestic partner and intend to remain committed to one another indefinitely;
(2)
(a) have a common residence, and intend to continue the arrangement; or
(b) have had a common residence and intend to resume having a common residence after an
assignment abroad for which my domestic partner did not accompany me; or
(c) would have a common residence, but are prevented from having one for the following
reasons¹:
(3) are at least 18 years of age and mentally competent to consent to contract;
(4) share responsibility for a significant measure of each other's common welfare and financial
obligations;
(5) are not married to, joined in civil union with, or domestic partners with anyone else; and
(6) are same-sex domestic partners, and not related in a way that would prohibit legal marriage in the
State in which we reside.
I further declare that I,
Name of Employee
(7) agree to file a statement of dissolution of the domestic partnership not later than 30 days after the
death of my domestic partner or the date of dissolution of the domestic partnership;
(8) understand that my domestic partner will be held to standards of conduct in the FAM that apply to
family members; and
(9) understand that falsification of information within this affidavit may constitute a criminal violation
under 18 U.S.C. 1001 and may lead to disciplinary action.
Signature of Employee
Name of Employee
Date (mm-dd-yyyy)
¹ If the employee cannot certify to the "common residence clause" except by filling in clause 2(c), the domestic partner relationship does
not qualify for benefits and obligations under the FAM and DSSR unless and until, after review of the employee's description, the Under
Secretary of State for Management or his or her designate determines that the circumstances described are sufficient to justify the waiver of
the common residency requirement.
3 FAM 1610
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Affidavit Pursuant to Declaring Domestic Partner Relationship Declaring Domestic Partner Relationship Form DS-7669

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 21 May 2019

Message

View Audit Log
Print With Audit Log
Duplicate Document