TERMINATION OF DOMESTIC PARTNERSHIP

I. Declaration

I declare that we,__________________________(Print Employee's Name) and

_____________________________ are no longer domestic partners.

I submit this Statement of Termination in order to cancel the Affidavit of Domestic

Partnership filed by me with The University of New Mexico on ____________________.

I mailed my former domestic partner a copy of this notice at

____________________________________________________________________

on _________________.

I declare, under penalty of perjury, that the above statements are true and correct.

Employee's Signature________________________________ Date____________

Print Employee's Name ______________________________________________

Employee's Address (if changed): __________________________________________

_____________________________________________________________________

Return completed form to the University Employee Services Office within thirty (30) calendar days from the date the domestic partnership terminated.

Comments may be sent to UBPPM@UNM.edu
http://www.unm.edu/~ubppm