FRANCISCO V.
AGUILAR
FOR OFFICE USE ONLY
Nevada Secretary of State
2250 Las Vegas Blvd North
Declaration of
Suite 400
North Las Vegas, NV 89030
Domestic
(775) 684-5708 option #8
[Link]
Partnership
Follow these instructions to complete and file this form to register as Domestic Partners: DP# :________________________________
1) Type or print legibly using blue or 4) All fields required. This form has two
black ink. Do not use whiteout. separate notarial acts. Job# :________________________________
2) Attach a $50.00 filing fee payable to Nevada 5) Hand delivery accepted at:
Mail this form with appropriate fees to:
Secretary of State. Use check, money order, • Carson City: 101 N. Carson Street, Suite 3
Nevada Secretary of State
or Credit Card Checklist Form. • NLV: 2250 Las Vegas Blvd. North, 1st Floor
3) Submit original declaration. No copies. Domestic Partnership Program
2250 Las Vegas Boulevard North, Suite 400
SECTION 1 – Applicant Information ( Do not use alias or nickname ) North Las Vegas, NV 89030
Yes* No Does either partner have an existing marriage or domestic partnership with another person?
*If “Yes”, you cannot file this declaration.
Partner 1:
Legal First Name Legal Middle Name Legal Last Name Suffix Date of Birth (mm/dd/yyyy)
Partner 2:
Legal First Name Legal Middle Name Legal Last Name Suffix Date of Birth (mm/dd/yyyy)
Residence
Address: Street Address City State Zip Code
Mailing
Address: PO Box or Street Address if different from residence City State Zip Code
SECTION 2 – Declaration
We, the undersigned, declare that:
1. We have chosen to share one another’s lives in an intimate 4. Neither of us is married or a member of another domestic partnership;
and committed relationship of mutual caring; 5. We are not related by blood in a way that would prevent us from being
2. We desire of our own free will to enter into a domestic partnership; married to each other in this State;
3. We have a common residence shared by both domestic partners 6. We are at least 18 years of age; and
on at least a part-time basis; 7. We are competent to consent to this domestic partnership.
SECTION 3 – Fees SECTION 4 – Delivery and Contact Information
FEES – Filing includes (1) B/W Paper or Digital Cert. Qty Subtotal DELIVERY – Choose a method for delivery of your certificate(s):
Declaration Registration 1 $50.00 Standard: USPS First Class Mail to mailing address above
Ceremonial Certificate $ 15.00 Expedite Mail: enclose a prepaid self-addressed flat envelope or
shipping label for the expedite service of your choosing
Addt’l Black/White Certificate $ 5.00
Hold for pickup at: North Las Vegas
Expedite Filing Fee $100.00
Digital Certificate: emailed to you. Email MUST be provided for delivery
PRINT Reset Form Total:
Email address:
CONTACT – For questions about your filing or to notify you of pickup, provide a phone number:
SECTION 5 – Signatures ( Declaration must be signed in the presence of a Notary Public )
I declare under penalty of perjury that the information provided on this Declaration of Domestic Partnership is true, correct and complete to the best of
my knowledge and belief and acknowledge that pursuant to NRS 239.330, it is a category C felony to knowingly offer any false or forged instrument for
filing in the Office of the Secretary of State.
X X
Signature of Partner 1 Signature of Partner 2
State of ________________________ State of ________________________
County of _______________________ County of _______________________
Signed and sworn to before me on _______________________ 20_____ Signed and sworn to before me on _________________________ 20_____
by _______________________________________________________ by ________________________________________________________
Print Name of Partner 1 Print Name of Partner 2
Signature of Notarial Officer Signature of Notarial Officer
( Notary Seal ) ( Notary Seal )
NVSOS DP Declaration Form Revised 09/05/2023
FRANCISCO V. AGUILAR
Nevada Secretary of State
2250 Las Vegas Blvd North
Suite 400
Notarization Guidelines for
North Las Vegas, NV 89030
(775) 684-5708 option #8
Domestic Partnerships
[Link]
To ensure that your declaration is not rejected for notarization errors, we offer the following
guidelines:
1) Please type or print. Make sure the names of both partners and the address(es) are
legible in Section 1.
2) The notarial officer completes the entire notarial section. It is the partner name (i.e.
document signer) that is printed by the notarial officer on the "by" line above the notarial
officer's signature.
3) Each signature requires a separate notary stamp and complete notarial language.
4) The notarial officer shall make sure the stamp has enough ink, does not smear, that the
whole stamp is clear, and that the completed notarial signature is legible.
5) A document may be notarized by a notarial officer in another state or country.
6) Below is how a document should be properly notarized.
X X
Signature of Partner 1 Signature of Partner 2
[ INSERT STATE ]
State of ________________________ [ INSERT STATE ]
State of ________________________
County of [ INSERT COUNTY ] [ INSERT COUNTY ]
_______________________ County of _______________________
[ MONTH DAY ]
Signed and sworn to before me on _______________ _______ 20_____ Signed and sworn to before me on ____[___________
[YEAR] MONTH DAY__] ________ 20_____
[YEAR]
[ NAME OF DOCUMENT SIGNER - PARTNER 1 ]
by _______________________________________________________ [ NAME OF DOCUMENT SIGNER - PARTNER 2 ]
by ________________________________________________________
Print Name of Partner 1 Print Name of Partner 2
Signature of Notarial Officer Signature of Notarial Officer
( Notary Seal ) ( Notary Seal )
Notary Stamp Notary Stamp
[Do not notarize this document. This is only a guideline.]
NVSOS DP Notary Guidelines Revised: 12/12/2022
FRANCISCO V. AGUILAR
Secretary of State
401 North Carson Street
Carson City, Nevada 89701-4201 ePayment Checklist
(775) 684-5708
Website: [Link]
All major credit cards are accepted. For security purposes, please do NOT email this
authorization form. Email is NOT a secure form of transmittal to protect your card information.
Processing Requested:
Regular 24-HOUR Expedite 4-HOUR Expedite (Apostille only)
2-HOUR Expedite 1-HOUR Expedite Same Day (Domestic Partnership only)
Order Information (required)
Entity Name/Order Reference:_______________________________________________________
Cardholder Name (as shown on credit card): __________________________________________________________________________________________________
Billing Street Address:_____________________________________________________________
City: __________________________________ State:_________ Zip: _________
Contact Phone Number: _____________________________________
Last 4 Digits of Credit Card: _________Card Type: VISA MasterCard Amex Discover
Authorized to Charge: ___________________________
By signing this form, I understand that there will be a non-refundable credit card payment processing
fee of 2.5% added to the total amount of the transaction. I understand if I do not wish to pay the credit
card processing fee, I can either mail a check, or pay in person by cash, check, or money order. I
certify that I am the cardholder and responsible for this payment in accordance with the issuing bank
cardholder agreement. I further understand that I am responsible for any penalty fees that may be
incurred if the credit card company denies my credit card payment.
Authorized Signature PRINT Completed Form ERASE / RESET FORM
X____________________________________________
PRINT, Then SIGN and DATE this form. DO NOT EMAIL this form Date:_____________
CREDIT CARD INFO: Your payment cannot be processed unless all fields are completed!
1. Credit Card Number: ____ ____ ____ ____ All 3 fields MUST
be completed!
2. Expiration Date:
This section will be
3. Security Code:* destroyed after the
*3-digit number found on the far right of the backside of VISA, MasterCard payment is processed.
and Discover cards
4-digit number found on the front right side of American Express card.
Form: 230105 rev: 8/1/2023