Fillable In order to cover your common law spouse, (LINECO)

Fill Online, Printable, Fillable, Blank In order to cover your common law spouse, (LINECO) Form

Use Fill to complete blank online LINECO pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

In order to cover your common law spouse, (LINECO)

On average this form takes 1 minutes to complete

The In order to cover your common law spouse, (LINECO) form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 5 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your LINECO forms online.

BROWSE LINECO FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Dear Member:
In order to cover your common law spouse, LINECO requires the following information.
To support that your state recognizes your marriage, we will need a copy of your most recent state tax
return, showing you are filing as a married couple and a notarized statement acknowledging the tax
return has been filed with the state.
If allowed by your state, we will accept a copy of the "Declaration and Registration of Informal
Marriage" from the county where your marriage was established. A tax return and notarized statement
will not be necessary with this declaration.
Enclosed is a LINECO Form regarding common-law marriage, which must be signed by you and your
common-law spouse, notarized and returned to us.
**PLEASE NOTE THAT BY EXECUTING THIS AFFIDAVIT
YOU ACKNOWLEDGE THAT YOUR COMMON-LAW MARRIAGE CAN BE DISSOLVED ONLY
THROUGH A JUDICIAL (i.e.
COURT) PROCEEDING.
If you have any questions, please call LINECO's toll- free number
1 (800) 323-7268 and ask for one of our claim service representatives.
Sincerely,
Enrollment Department
AFFIDAVIT
I, BBBBBBBBBBBBBBBBBBBBBBBBBB, submit this affidavit, along with certain additional documents, in
order to induce the Line Construction Benefit Fund to treat ____________________ as my lawful
spouse and as an eligible dependent under the terms of the Line Construction Benefit Fund plan of
benefits.
I certify that_____________________ became my spouse on BBBBBBBBBBBBBBBwhen I entered into a
common law marriage with her/him under the laws of the state of .
Since that date, my spouse and I have cohabited together and have held ourselves out to the public as
being married.
(Signature of Employee)
(Social Security Number)
(Signature of Spouse)
(Social Security Number)
(Street Address)
(City, State and Zip)
SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF , 20 _ _ _ .
____________________________________________
(NOTARY PUBLIC)
*PLEASE NOTE THAT BY EXECUTING THIS AFFIDAVIT YOU ACKNOWLEDGE THAT
YOUR COMMON LAW MARRIAGE CAN BE DISSOLVED ONLY THROUGH A JUDICIAL (i.e.,
court) PROCEEDING.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

In order to cover your common law spouse, (LINECO)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 15 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document