Nassau County, NY · Nassau County
Dependent Tax Affidavit for Domestic Partner Enrollment in NYSHIP
This affidavit lets a NYSHIP enrollee report whether an already-enrolled domestic partner qualifies as a dependent for federal tax purposes.
At a glance
- Issued by
- City of Nassau County · Nassau County, Nassau County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- nassaucountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Use this form only to change the tax status of a domestic partner already enrolled in NYSHIP; it is not for adding a new partner. The enrollee identifies the dependent, selects whether the partner qualifies under Internal Revenue Code Section 152, and provides identifying information and an authorization. The form notes that all four qualifying-relative tests must be met for federal dependent status.
Who needs it
A NYSHIP enrollee with an already-enrolled domestic partner who needs to change the partner’s dependent tax status should complete this affidavit.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document does not require notarization; the enrollee signs and dates the affidavit.
How to submit this form
- 1
Download the Affidavit
Download the form for changing the tax status of a domestic partner already enrolled in NYSHIP.
- 2
Complete the Form
Enter the dependent and enrollee information and select whether the partner qualifies as a dependent.
- 3
Review Your Information
Review the tax-status selection and authorization before signing and dating the form.
- 4
Submit the Form
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the NYSHIP Dependent Tax Affidavit do?
- It lets an enrollee report whether an already-enrolled domestic partner qualifies as a dependent under Internal Revenue Code Section 152.
- Can I use this form to add a domestic partner to NYSHIP?
- No. The form says it is only for changing the tax status of a domestic partner who is currently enrolled. Use the NYSHIP Domestic Partner Enrollment Application to add a partner.
- Do I need a notary for the NYSHIP Dependent Tax Affidavit?
- No. The enrollee signs and dates the affidavit without a notary.
- How do I submit the NYSHIP Dependent Tax Affidavit?
- Submit it to the city department named on the form; check the city website for current contact details.