§ 14A-4. Form of declaration.

The affidavit of domestic partnership shall be executed and notarized on a form provided by the Town Clerk. Such affidavits shall contain the following information and shall be in substantially the following form:

We, the undersigned, do hereby declare ourselves to be domestic partners. We reside in the Town of North Hempstead at

, or one of us is employed by the Town of North Hempstead. We are each 18 years of age or older, unmarried and competent to enter into a contract. We are not related to each other by blood in a manner that would bar marriage under the laws of the State of New York. We share a common household. We are in a close and committed, financially interdependent personal relationship and intend to remain in the relationship. We are each other's sole domestic partner and intend to remain each other's sole domestic partner. Neither of us has terminated another domestic partnership within the last 60 calendar days. Each of us agrees to file a termination statement in the event that this domestic partnership is terminated.