Get Legally Domiciled Adult Affidavit

Completing the Legally Domiciled Adult Affidavit is an essential step for individuals seeking to confirm their relationship status and secure benefits. This guide will provide you with clear and concise instructions on filling out the form online, ensuring accuracy and compliance with requirements.

Follow the steps to successfully complete your affidavit online.

1. Click 'Get Form' button to access the Legally Domiciled Adult Affidavit and open it in your preferred editing tool.
2. Begin with Part 1, where you will input general information about both you (the associate) and your legally domiciled adult (LDA). Fill in names, addresses, phone numbers, and other identifying details as requested.
3. Proceed to Part II. Choose either Category A or B for eligibility affirmation. Carefully read each statement and check 'Yes' or 'No' based on the criteria applicable to your situation. Complete this section thoroughly to ensure eligibility.
4. In Part III, indicate your selection for LDA election and tax treatment. Mark the appropriate category and confirm your understanding of the implications associated with each category regarding taxes and coverage eligibility.
5. For Part IV, gather and check at least three supporting documents to verify the LDA’s eligibility. Ensure the documents are dated at least six months prior to the effective enrollment date.
6. Finally, in Part V, both the associate and the LDA must review and sign the affidavit. Include the date for each signature. Remember, submitting false information can lead to serious consequences.

Get started with your Legally Domiciled Adult Affidavit online today!