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Registration of Domestic Partnerships Regulations made under Section 59 of the
Vital Statistics Act
R.S.N.S. 1989, c. 494
O.I.C. 2001-263 (May 31, 2001, effective June 4, 2001), N.S. Reg. 57/2001
1 These regulations may be cited as the Registration of Domestic Partnerships Regulations.
2 The forms for the registration of domestic partnerships are as set out in Schedule A as follows:
(a) a domestic-partner declaration pursuant to Section 53 of the Vital Statistics Act shall be in Form A - Declaration of Domestic Partnership;
(b) a statement of termination pursuant to clause 57(a) of the Vital Statistics Act shall be in Form B - Statement of Termination of Domestic Partnership;
(c) an affidavit pursuant to clause 57(a) of the Vital Statistics Act, swearing or affirming that a domestic partnership has ended by separation, shall be in Form C - Affidavit that Domestic Partnership Ended by One-Year Separation.
Schedule A Form A - Declaration of Domestic Partnership
Section 53 of the Vital Statistics Act
Office of the
Declaration of Domestic Partnership
Registration Number Domestic Partners' Information
Name Surname Surname Given Names Given Names Birthdate Age Date of Birth (Month by name, day, year) Age Date of Birth (Month by name, day, year) Status (Never Married, Divorced, Widowed, Domestic Partnership Terminated) (Never Married, Divorced, Widowed, Domestic Partnership Terminated) Residence Address: Address: City, Town or other placeProvince or Country
City, Town or other placeProvince or Country
We, ________________________________________ and __________________________________________ hereby formally record and declare that:
(a) each of us is 19 years of age or older
(b) neither of us is a party to an ongoing marriage or domestic partnership
(c) each of us is a resident or owner of real property in the province of Nova Scotia
(d) we have a conjugal relationship and as such intend our relationship to continue
(e) we intend each of us to have the same rights and obligations as spouses in accordance with subsection 54(2) of the Vital Statistics Act.
We understand that the relationship established by this declaration will terminate after the earliest of the following occurrences:
(a) we file with the Registrar an executed Form B - Statement of Termination
(b) we have a separation agreement registered with the court pursuant to Section 52 of the Maintenance and Custody Act
(c) we file with the Registrar an executed Form C - Affidavit that Domestic Partnership Ended by One-Year Separation
(d) one of us marries a third party
Signatures of Domestic Partners Signature of Witnesses Date Signed Date of registration Certification of Deputy Registrar General I certify this declaration was filed at-------------------------------- on ---------------, 20 -- Signature of Deputy Registrar General
This declaration is valid under Nova Scotia law, but may be limited by federal law or the law of another province or territory.
Form B - Statement of Termination of Domestic Partnership
Clause 57(a) of the Vital Statistics Act
To the Registrar of Vital Statistics:
We, ____________________ and _____________________, hereby formally record and declare that:
(a) we filed a Form A - Declaration of Domestic Partnership on ______________ (date), filed under
registration number ________________________
(b) we have been living separate and apart as of _______________ (date)
(c) we intend to continue doing so, and
(d) our domestic partnership is ended.
Signature of Witness
Signature of Domestic Partner
Signature of Witness
Signature of Domestic Partner
Filed with the Office of the Registrar General, _____(month and day)______, ___(year)____.
Signature of Deputy Registrar General
Form C - Affidavit that Domestic Partnership Ended by One-Year Separation
Clause 57(b) of the Vital Statistics Act
I, ______________________________of ___________________________ (address), have personal knowledge of the following matters and make oath/affirm as follows:
1. I filed a Form A - Declaration of Domestic Partnership with ___________________ on ______________ (date).
2. __________________ and I have been separated since _____________ (date), which is more than one year before this affidavit is made. We have not during that time resumed cohabitation for a period or periods totalling more than 90 days with the intent to reconcile.
3. It is our intention that our domestic partnership not continue.
Sworn before me at the _____________________ of _____________________
in the province of ____________________________________,
_____(month and day)_______, ___(year)___.
Commissioner of Oaths, Notary Public,
Justice of the Peace
Signature of Person making Affidavit