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12-9A.7   Severability.
   The provisions of this Section are severable. If any of its provisions are held invalid by a court of competent jurisdiction, all other provisions shall continue in full force and effect.
(CBC 1985 12-9A.7; Ord. 1993 c. 12 § 7)
12-9A.8   Forms.
   The City Clerk shall distribute copies of the forms following this Section to those who request them. Said forms shall be considered a part of this Section, and consist of the following:
   (A)   Statement of Domestic Partnership;
   (B)   Statement of Terminating Domestic Partnership; and
   (C)   Statement of Additional Dependents.
(CBC 1985 12-9A.8; Ord. 1993 c. 12 § 8)
Editor’s note:
   The copies of the forms referred to herein may be found at the end of this Section.
12-9A.9   Employee Health Insurance Study.
   (A)   The city shall conduct a study of:
      (1)   Possible cost-saving measures which would reduce the city’s costs for the provision of health insurance benefits to its employees; and
      (2)   Costs and other issues related to the extension of health insurance benefits to city employees’ domestic partners and their dependents.
   (B)   This study shall be completed, and copies shall be made available to the Boston City Council, by June 30, 1994.
(Ord. 1993 c. 12 § 9)
FORM A: STATEMENT OF DOMESTIC PARTNERSHIP
 
   CITY OF BOSTON
   OFFICE OF THE CITY CLERK
 
   Statement of Domestic Partnership
 
We,                                                                           Full name
   Date of Birth:    / /
               Month/Day/Year
 
and                                                                           Full name
   Date of Birth:    / /
               Month/Day/Year
 
declare that:
 
   (1)   we share basic living expenses;
   (2)   we assume responsibility for each other’s welfare and for the welfare of any dependents listed below;
   (3)   we are at least eighteen years of age;
   (4)   we are competent to enter into a contract;
   (5)   we are each other’s sole domestic partner;
   (6)   we are not married to anyone, nor related to each other by blood closer than would bar marriage in the Commonwealth of Massachusetts; and
   (7)   we shall notify the City Clerk of any change in the status of our domestic partnership.
 
We became each other’s domestic partner on                                                       
Our domestic partnership is a family which includes the following dependents
                                                                         
                                                                         
                                                                          
                                                                          
                                                                         
I declare under the pains and penalties of perjury that to the best of my knowledge the foregoing statements are true and correct.
 
Signed:                                                                  
 
Printed Name:                                                        
 
Date:                                                                      
 
Signed:                                                                   
Printed Name:                                                         
 
Date:                                                                      
 
FORM B: STATEMENT OF TERMINATING DOMESTIC PARTNERSHIP.
 
   CITY OF BOSTON
   OFFICE OF THE CITY CLERK
 
   Statement of Terminating Domestic Partnership
 
I declare that: __________________________
 
   (1)                                                     and I are
       Full name of domestic partner
 
No longer domestic partners; and
 
   (2)   I notified my former domestic partner of this statement in person/by certified mail (please circle one) on
 
                                                                    
      Date
 
I declare under the pains and penalties of perjury that to the best of my knowledge the foregoing statements are true and accurate.
 
Signed:                                                                  
 
Printed Full Name:                                                    
Date:                                                              
 
FORM C: STATEMENT OF ADDITIONAL DEPENDENTS.
 
   CITY OF BOSTON
   OFFICE OF THE CITY CLERK
 
   Statement of Additional Dependents
 
Our domestic partnership/extended family (circle appropriate term) now includes the following additional dependents:
                                                                              
                                                                                                                                                                 
I declare under the pains and penalties of perjury that to the best of my knowledge the foregoing statements are true and correct.
 
Signed:                                                                  
 
Printed Full Name:                                                  
 
Date:                                                                     
 
12-10   RESERVED.
   [Reserved]
Editor’s note:
   Former Section 12-10, Establishing the Boston Employment Commission, previously codified herein and containing portions of Ordinance Nos. 1986 c. 12, 1986 c. 13, 1986 c. 17, and 2010 c. 9 were repealed in their entirety by Ordinance No. 2017 c. 1, § 1.
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