Domestic Partnership Form [blank form]


Domestic Partnership Form [blank form]

Alternative Title

Declaration of Domestic Partnership


This form was created after the passing of "The Health Benefits Expansion Act" of DC on 11 June 1992, which created a domestic partner registry. Congressional riders prohibited the use of federal or local funds to enact the law, blocking registration.

Per the description of the form's primary author and donor Mindy A. Daniels, this form was made part of an Executive Order signed by then DC Mayor Sharon Pratt, just moments before the Congressional defunding. Mindy Daniels came up with this form of registration so so that domestic partners could register without using government monies, which was prohibited by Congress when they defunded the legislation.

As DC government staff were prohibited to deal with the matter, a certified mail postal receipt that it was submitted to the government was all that was necessary for the domestic partnership to be deemed valid.

Original Format

This blank form is available and stored as part of the Mindy A. Daniels collection.



Mindy A. Daniels Gay & Lesbian Activists Alliance (GLAA), “Domestic Partnership Form [blank form],” Rainbow History Project Digital Collections, accessed August 18, 2018,

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