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Get BCBS Common Law Marriage Affidavit 2019-2024

COMMON LAW MARRIAGE AFFIDAVIT The following information is required before a request to add a common law spouse or a dependent child. Insured s Name SSN Name of Common Law Spouse Affidavit of Common Law Marriage We the undersigned being first duly sworn attest that the following statements are true. We are residents of the State of. I am the wife/husband of Insured. We have mutually consented and agreed to be married and are married to each other. There is no legal impediment of our marriage including but not limited to a prior marriage of either party that has not been legally terminated by death or divorce. As evidence of our marriage contract we cohabit together as husband and wife refer to each other as husband and wife and are known by our families as the community as husband and wife. With the result that we are treated and referred to a husband and wife by our families our co-workers and in the community in which we reside. The date of our Common Law Marriage is Signature of Insured STATE OF COUNTY OF Sworn to before me a notary public by said this day of personally known to me on Notary Public My commission expires Signature of Common Law Spouse 10. We are residents of the State of. I am the wife/husband of Insured. We have mutually consented and agreed to be married and are married to each other. There is no legal impediment of our marriage including but not limited to a prior marriage of either party that has not been legally terminated by death or divorce. There is no legal impediment of our marriage including but not limited to a prior marriage of either party that has not been legally terminated by death or divorce. As evidence of our marriage contract we cohabit together as husband and wife refer to each other as husband and wife and are known by our families as the community as husband and wife. As evidence of our marriage contract we cohabit together as husband and wife refer to each other as husband and wife and are known by our families as the community as husband and wife. With the result that we are treated and referred to a husband and wife by our families our co-workers and in the community in which we reside. With the result that we are treated and referred to a husband and wife by our families our co-workers and in the community in which we reside. The date of our Common Law Marriage is Signature of Insured STATE OF COUNTY OF Sworn to before me a notary public by said this day of personally known to me on Notary Public My commission expires Signature of Common Law Spouse 10. We are residents of the State of. I am the wife/husband of Insured. We have mutually consented and agreed to be married and are married to each other. There is no legal impediment of our marriage including but not limited to a prior marriage of either party that has not been legally terminated by death or divorce. As evidence of our marriage contract we cohabit together as husband and wife refer to each other as husband and wife and are known by our families as the community as husband and wife. .

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