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Get BCBS 10.290 2006

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 inc.

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