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EXHIBIT C <br /> <br /> City of Eugene <br /> Termination of Domestic Partnership <br /> <br /> I/We declare under penalty of perjury under the laws of the State of Oregon that the statements <br /> below are true and correct; I/we also understand that [/we cannot file a new Domestic Partnership <br /> Registration until six months following the filing of this Statement of Termination. <br /> <br /> The partnership between: <br /> <br /> First Party: <br /> <br /> First M.I. Last <br /> <br /> Address City, State and Zip Code <br /> <br /> Second Party: <br /> <br /> First M.I. Last <br /> <br /> Address City, State and Zip Code <br /> <br /> which was registered on ,20__, in Eugene, Oregon, <br /> terminated on .20 (Domestic Partnership Registration <br /> No. .) <br /> <br /> First Party: Dale: <br /> Signature <br /> <br /> Second Party: Date: <br /> Signature <br /> <br /> Note: If only one partner signs, that partner must provide evidence <br /> (certified mail receipt) that the signing partner attempted to notify <br /> the other partner of the termination of the partnership. <br /> <br /> TO BE COMPLETED BY CITY PERSONNEL: ~ Certified marl receipt prowded (if applicable) <br /> Date Filed: City Representative: <br /> <br /> Rev 01/2003 <br /> <br /> <br />