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Get Does Brazoria County Recognize Domestic Partner Insurance Form

(Employee/Retiree - Print Name) AMFPHKGOBPHKCKFK AJALHLPODLBDEIKK ANAOMFAHCDJDDKOK ACOOCAAGEOGMICEK and I, ( Domestic Partner ), (Domestic Partner - Print Name) affirm, under penalty of perjury, that we satisfy all of the following requirements for a domestic partnership for purposes of Plan eligibility for benefits: (A) We intend to remain each other s sole domestic partner indefinitely; and (B) We are each at least 18 years old (or of legal age); and (C) We.

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