The Maryland Domestic Partnership form, officially known as the Affidavit for Domestic Partnership and Domestic Partner’s Dependents, is a document that certifies the eligibility of domestic partners and their dependents for certain benefits. It stipulates that both partners are at least 18 years old, not related by blood or marriage within four degrees of consanguinity, not married or in a domestic or civil union with someone else, and have been in a committed relationship for at least 12 consecutive months, among other criteria. Individuals seeking to provide their domestic partner or their partner's dependents with benefits coverage must complete this form, demonstrating financial interdependence and shared residence, to potentially qualify for tax-favored treatment. To ensure you have properly filled out the form to include your domestic partner or their dependents on your benefits, click the button below.
The Maryland Domestic Partnership form serves as a comprehensive affidavit for individuals seeking to establish or affirm their domestic partnership status, as well as for those aiming to add a domestic partner or a dependent child of a domestic partner to their coverage plans. This document is crucial for couples who, although not joined by marriage, desire to be recognized as domestic partners under the guidelines stated in the benefits guide. It outlines specific criteria that the partners must meet, such as being at least 18 years old, not related by blood or marriage within four degrees of consanguinity, and not being in another domestic partnership or marriage. Additionally, it emphasizes the need for financial interdependence through joint financial responsibilities or mutual care directives, including health care agent designations and durable powers of attorney. For adding dependents, it specifies the necessary proofs of relationship and dependency, including the child's eligibility based on age, marital status, and capability requirements. Moreover, it touches upon the tax implications for both the domestic partner and any dependents, detailing conditions under which they may qualify for tax-favored treatment. The form culminates with a solemn affirmation of the truthfulness of the information provided, underscoring the legal consequences of falsifying such a document. This not only includes potential termination of enrollment and coverage but also highlights the possibility of civil actions for any false statements made, emphasizing the serious legal obligations for those who sign it.
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
Filing for domestic partnership in Maryland involves completing a specific affidavit that requests detailed information about the partnership and any dependents involved. This process not only legally recognizes a domestic partnership but also plays a crucial role in the allocation of benefits. The steps outlined below are designed to make completing this form as straightforward as possible, ensuring that applicants provide all necessary information accurately to avoid any delays or issues with their application.
Once the affidavit and all required documents are completed and signed, the next steps usually involve submitting the form to the relevant department or authority, typically the Department of Budget and Management, Employee Benefits Division in Maryland. It is critical to contact this department directly or refer to their instructions for submission, as requirements may vary. Following submission, the application will be reviewed, and if approved, the domestic partnership and any dependent benefits will be recognized for the purposes outlined in the form.
The Maryland Domestic Partnership form, officially known as the Affidavit for Domestic Partnership and Domestic Partner’s Dependents, is a document that must be completed by employees or retirees who wish to add their domestic partner or the dependent child of a domestic partner to their benefits coverage. This affidavit certifies that the individuals meet specific criteria regarding age, relationship status, mutual financial interdependence, and residence, among others, as outlined in the benefits guide.
This form should be filled out by employees or retirees seeking to enroll their domestic partner and/or their partner's dependent children under their benefits plan. It's necessary for both partners to meet the defined criteria and provide proof of their domestic partnership through various accepted documents.
Financial interdependence can be demonstrated by providing any one of the following documents with appropriate dating:
To establish a common primary residence, applicants must provide one of the following:
Yes, a domestic partner can qualify as an eligible tax dependent under certain conditions. The coverage for the domestic partner may receive tax-favored treatment if all three of the following apply:
Providing false information in the Affidavit for Domestic Partnership and Domestic Partner’s Dependents can lead to severe consequences, including an investigation and prosecution, termination of enrollment and coverage, and potential legal action. The affidavit explicitly states that civil action can be brought against the declarants for any losses due to false statements, and reasonable attorney fees may also be recovered. Furthermore, employment-related actions may be taken against active employees who provide incorrect information.
Failing to accurately establish the age and relationship criteria: Many individuals overlook the critical step of ensuring that both parties are at least 18 years old and not related by blood or marriage within four degrees of consanguinity. This is essential for meeting the basic eligibility criteria for a domestic partnership in Maryland.
Overlooking financial interdependence documentation: Couples often neglect to provide sufficient documentation that proves their financial interdependence. Specific documents such as joint leases, bank accounts, or beneficiary designations for life insurance and wills are vital for substantiating the mutual support and maintenance aspect of the partnership.
Incorrectly proving common residence: It's common for individuals to misinterpret what constitutes proof of a common primary residence. Acceptable documentation includes a joint lease or deed, driver's licenses with the same address, or utility bills in both names. Skipping this step or providing insufficient evidence can jeopardize the application.
Omitting required signatures and dates: A surprisingly frequent mistake is the failure to have both signatures of the partners along with the appropriate dates at the bottom of the form. This oversight can render the entire affidavit invalid.
Incomplete tax affidavit section for the domestic partner: Individuals frequently miss initialing the tax-dependent criteria that apply to their domestic partner or fail to include a copy of their most recent income tax filing. This documentation is crucial for the partner to receive potential tax-favored treatment.
Neglecting dependent affidavit requirements: For those adding a dependent child of the domestic large partner, it's common to ignore or incorrectly fill out the section regarding the dependent's eligibility. This includes failing to provide necessary documents that prove the child's relationship to the domestic partner, the child's marital status, and the child's age or capability requirements.
For individuals in Maryland considering or navigating the process of establishing a domestic partnership, the primary document of focus is the Maryland Domestic Partnership Form. However, this is just the starting point. Numerous other documents and forms often accompany this initial step, serving diverse functions from establishing financial interdependence to addressing tax considerations. These auxiliary documents play a critical role in ensuring that all legal and financial aspects of a domestic partnership are properly recognized and structured.
When completed attentively and filed correctly, these documents, in concert with the Maryland Domestic Partnership Form, create a comprehensive legal framework for domestic partners. They ensure recognition and protection under state laws, assisting partners in navigating the aspects of shared life from property ownership to health care decisions. It's imperative that individuals entering into a domestic partnership consider each of these documents carefully, understanding their significance and ensuring that all details are accurate and up-to-date. Moreover, consulting with a legal professional can provide invaluable guidance, helping to safeguard the rights and well-being of both partners in a domestic partnership.
The Maryland Domestic Partnership form is similar to other legal documents that create or affirm domestic arrangements, offering a spectrum of rights and responsibilities to the parties involved. These similarities extend to documents like a Civil Union Agreement and a Common Law Marriage Affiditation, each reflecting differences in legal recognition and the specifics of the accorded rights.
A Civil Union Agreement shares similarities with the Maryland Domestic Partnership form in that it is a legal document used by couples to secure many of the same legal protections and benefits as marriage. Both documents require the parties to attest to their commitment to each other and to meet certain criteria, such as sharing a household and not being married to someone else. However, the Civil Union Agreement typically applies to a broader array of legal rights and is recognized in fewer states, making its legal applicability more limited in comparison.
Similarly, a Common Law Marriage Affidation is another document that resembles the Maryland Domestic Partnership form. Common Law Marriage, recognized in a handful of states, allows couples to be considered legally married without a formal ceremony or marriage license, provided certain conditions are met over a period. Like the Maryland form, it requires couples to present evidence of their relationship's longevity, shared residence, and combined financial assets. Yet, its key difference lies in the legal recognition of the couple as married, which impacts federal tax filings and inheritance rights, unlike domestic partnerships.
When completing the Maryland Domestic Partnership form, certain steps should be followed to ensure the process is accurate and compliant. Here are some dos and don'ts to consider:
It's crucial to approach the process with honesty and attention to detail to avoid any potential legal or financial ramifications. Following these guidelines will help ensure that the application for domestic partnership benefits is completed accurately and effectively.
Understanding the Maryland Domestic Partnership form involves clarifying common misconceptions that may arise from its complexity and the specificity of the conditions it outlines. A detailed examination sheds light on these misunderstandings, promoting accurate comprehension of the form’s implications and requirements.
Domestic partnerships provide the same legal benefits as marriage: This is not entirely true. While domestic partnerships in Maryland offer certain benefits, such as eligibility for partner health insurance, they do not provide all the rights and protections of marriage, especially on a federal level.
Domestic Partnership is easily reversible: Contrary to some beliefs, ending a domestic partnership can be as complex as dissolving a marriage, involving legal formalities and potential complications, especially if shared property or dependents are involved.
Financial interdependence is optional for registration: The affidavit requires proof of financial interdependence among partners. This is not optional but a mandatory condition to establish the validity of the partnership.
Any shared residence qualifies as a common primary residence: The form specifies that the partners must share a common primary residence, corroborated by providing specific documents. Not any shared residence meets this criterion without the proper documentation.
Dependents automatically receive coverage: Adding a domestic partner’s dependents to your coverage isn't automatic and requires fulfilling additional conditions, including providing documentation to prove the dependent's status and relationship.
Domestic partnerships are recognized in all states: Recognition of domestic partnerships varies by state. While Maryland may recognize the arrangement for certain benefits, it's not universally acknowledged across the United States.
There are no consequences for false information: The affidavit clearly states that willful falsification of information can lead to legal actions, including termination of coverage and potential prosecution. Submitting accurate information is of utmost importance.
Tax benefits are guaranteed: Tax benefits for domestic partners are not assured. Eligibility for tax-favored treatment of a domestic partner’s coverage depends on meeting specific IRS criteria, which does not apply universally to all domestic partnerships.
All children of a domestic partner are eligible for coverage: Only children who meet certain criteria—such as age, marital status, and dependency status—are eligible to be added to health benefits coverage. Documentation must be provided to support the claim.
Clarification of these misconceptions is crucial for individuals considering or currently in a domestic partnership in Maryland. Understanding the specific terms and conditions of the affidavit ensures that partners can accurately comply with its requirements and avoid any unintended legal or financial consequences.
Filling out the Maryland Domestic Partnership form is an essential step for employees or retirees who wish to add a domestic partner or a dependent child of a domestic partner to their coverage. It is vital to understand the requirements and implications of this process. Below are key takeaways to guide individuals through this process.
Lastly, both partners are required to sign the affidavit, affirming all the information provided under penalty of perjury, acknowledging the consequences of providing false information. This affirmation is a legal acknowledgment of the partnership's authenticity and the accuracy of the provided information. Individuals are advised to inform the Department of Budget and Management, Employee Benefits Division promptly upon any change in circumstances related to the affidavit. By understanding and accurately fulfilling these requirements, individuals can ensure a smoother process in adding domestic partners or their dependents to their coverage.
Maryland Form 502cr - Refundable credits distinguish between economic development incentives, providing targeted support for businesses.
Maryland Circuit Court Forms - Provides space for listing additional names to be indexed, allowing for a thorough documentation process in public records.
Maryland Medicaid Application - Includes a section for recording financial eligibility, ensuring patients' economic circumstances are considered in the eligibility process.