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Ue: 1. We share a permanent residence (unless residing in different cities, states or countries on a temporary basis). 2. We are each other s sole (Circle one) same-sex/opposite-sex domestic partner, have been in this relationship for at least six (6) months, and intend to remain in this relationship indefinitely. 3. We are of the (Circle one) same sex/opposite sex as each other and neither of us is currently married to or legally separated from another person under either statutory or co.

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