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Domestic Partners - Washington Secretary of State

Page 1 of 2 Declaration of State Registered Domestic Partnership See attached detailed instructions Filing Fee $ Filing Fee with Expedited Service $ PARTNERSHIP DECLARATION Chapter RCW PARTNER 1 Name: First Middle Last Place of Birth: City State Country Date of Birth: Gender: Male FemalePARTNER 2 Name: First Middle Last Place of Birth: City State Country Date of Birth: Gender: Male FemaleADDRESS Mailing or Postal Address (optional): _____ City _____State Zip Code _____ Street Address: _____ City _____State Zip Code _____ This Box For Office Use Only Registration Number: Domestic Partnership - Declaration Washington Secretary of State Revised 07/14 Page 2 of 2 Declaration of State Registered Domestic Partnership Important information: Registration of a Domestic partnership may affect property and inheritance rights and is not a substitute for a will, deed, or partnership agreement.

$50.00 and write “EXPEDITE” on the outside of the envelope. All payments must be received in US Dollars. All fees are non-refundable. Mail completed forms and payment to: Secretary of State . Corporation Division . 801 Capitol Way S . PO Box 40234 . Olympia WA 98504 -0234

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