A   C o m p r e h e n s i v e   M a n u a l
We acknowledge and understand that the University of Minnesota has advised us to consult with an attor 
ney regarding the legal consequences of signing this declaration.
We provide this information for the sole use of the University of Minnesota and for the sole purpose of
determining our eligibility for domestic partner benefits provided by the University of Minnesota.  If we
do not provide this information, we understand we will not be eligible for domestic partner benefits.  We
understand that this affidavit constitutes private information under the Minnesota Government Data Prac 
tices Act, Ch. 13, and will not be disclosed to anyone outside of the University of Minnesota except as
authorized under the terms of that Act.
___________________________ ___________________________
Signature of Employee/Student  
Signature of Partner
Date:_____________________ Date:______________________
A p p e n d i x   D :   S a m p l e   A f f i d a v i t     M     2 8 1


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