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More Magazines Recommendations Info Affidavit of Domestic Partnership Submit this affidavit to University Human Resources (Attn: COBRA Specialist, Poplars E165, IU Bloomington) Employee Information: Please check one: IU Faculty/Staff GME Resident Graduate Appointee UHR 11/2013 Employee Name (Last, First, MI): 10-digit ID: Date of Birth: / / Gender: Social Security Number: - - Address: City: State: Zip: DOMESTIC PARTNER Information: Domestic Partner Name (Last, First, MI): Partnership Began On: / / Date of Birth: / / Gender: Social Security Number: - - Address: City: State: Zip: DOMESTIC PARTNER DEPENDENT CHILD Information: List only the domestic partners children who meet the eligibility requirements outlined at hr.iu.edu/benefits/needknow.html

If you've experienced diarrhea over the course of several weeks it may indicate a more serious medical problem like celiac disease or irritable bowel syndrome

Ideal for regular nicotine users and those seeking a smoke-free, odor-free nicotine alternative on-the-go

Leaf moisture reduction reaches nearly 80% during processing, ensuring high nicotine retention of around 2.5% to 3.2%