Notarized Statutory Declaration of Common-Law Union

Province/Territory:

City/Town:

Date:

Declarant Name:

Address:

Date of Birth:

Partner Name:

Partner Address:

Partner Date of Birth:

Declaration:

I, the undersigned, solemnly declare that I have lived with the person named above in a conjugal relationship as common-law partners since:

Date (YYYY-MM-DD):

Further Details or Statements:

Signature of Declarant:

Name:

Date:

Signature of Notary Public/Commissioner:

Name:

Date:

Seal: