EFTA00724798.pdf

TCC INTERNATIONAL Affidavit ofDomestic Partnership STATE OP NEW YORK COUNTY OF 1. I, Cc_ evwc. S 41 o n cs.t, cc" 5 ,and Dt3etitt,_,rnees Currently share a primary residence and the common nccessit life intend to do s t,y Bcti indefinitely at: 2. We affirm that the effective date of this domestic partnership is la t 4O0 3. We aro not currently married to, or a Domestic Partner of, another person under either statutory or common law. 4. Wo aro at least (18) years old. 5. We are not related by blood closer than would bar marriage in the State ofNew York and aro competent to enter into a contract. 6. We are currently financially interdependent and submit the following documents to support at least two of the following conditions of such financial interdependence: • A joint ownership of a residence • A joint ownership of an automobile • A joint checking, bank or investment account • A joint credit account • A lease for a residence identifying both partners as tenants • A will and/or Life Insurance policies which designates the other as primary beneficiary 7. We agree to notify the TCC International if there is a Termination of this Domestic Partnership. 8. After such termination we understand that another affidavit of Domestic Partnership cannot be filed until six (6) months after the termination of this partnership. EFTA00724798 9. We understand that any person/employer/company who suffers any loss because of a false statement contained in an affidavit of Domestic Partnership may bring a civil action against us to recover their losses, including reasonable attorney's fees. 10. We hereby certify under the penalty of perjury under the laws of the State of New York that the statements above are true and correct. Name (Print) Name (Print) rpam en cr4 e 'Da; S5 Signature Signature Address Address. Telephone Telephone Sworn to before me this day of Sworn to before this 24-- day of 20 t9 ,20 Li Notary Public Notary Public PAUL GUSAK Notary Public - State of New York PAUL GUSAK No. 016U6194035 Nary Public - State of New 'Auk Oualtfled in Kings County No. OICIIF" Commission Expires September 29, 2012- Qualified • Commission Expires September 29, 20_ PAUL GUSAK Notary Public - State of New York No. 01GU6194035 Qualified In Kings County Commission Expires September 29, 2012._ EFTA00724799