Downloading a Form to Your Computer

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  2. Select the folder you want to save the file in and then click "Save."
  3. Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.

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Effective Date: 



Updated: 1/2004


To provide an alternative means for couples that are common-law married to provide a sworn statement declaring their informal marriage and the date of marriage.


When to Prepare

Use to verify the date of a common-law marriage when the couple indicates that they have not filed a Declaration of Informal Marriage with the county clerk's office. Use to determine whether or not to exclude a new common-law spouse's earnings. See A-1369, New TANF Spouse's Earnings, in the Texas Works Handbook.

Form Retention



The client and common-law spouse complete each section and signs the form in Section III.