Rev.03/2016MARATHON PETROLEUM AFFIDAVIT OF COMMON LAW MARRIAGE(This fo - PDF document

Common Law Marriage Certification of Common Law Spouse Relationship Attached to this certificationis a copy of formal documentary evidence of a common law marriage. One of the following mustbe provided:certificate of common law marriage/informal marriage (or other comparable document) issued by Last Name First Name Middle Initial Employee Number Address City State Zip Code Gender Last Name First Name Middle Initial Date of Birth Address City State Zip Code Gender Common Law Marriage Certification of Common Law Spouse Relationship ��2 &#x/MCI; 0 ;&#x/MCI; 0 ; &#x/MCI; 1 ;&#x/MCI; 1 ;We are each legally free to consent to marriage, including:We are each at least 18 years of age.We are each mentally competent to consent to marriage.We are not related by blood to a degree of closeness that would prevent marriage under the laws of the state inwhich we reside.Neither of us is currently married to another person (which means that any prior marriage, including any common law marriage, has been terminated by death or divorce).AcknowledgementsWe acknowledge that:We are required to provide documentation substantiating this common law marriage.We understand that signing this certificationcould be enough to establish a common law marriage that might not otherwise be held to exist, and could bring with it the full legal consequences of a marriage.The Company’s recognition of our common law marriage will apply to all Company policies and benefit plans, including but not limited to the Marathon Petroleum Retirement Plan and Marathon Petroleum Thrift Plan. Among other consequences, thismeans that when required by law or the terms of an affected Plan, spousal consent will be required for certain distributions and changes in beneficiaries.We have an obligation to notify the Company within daysof the earliest of a) the death of my common law spouse, or b) divorce from my common law spouse.Marathon Petroleum Company LP is not providing legal or tax advice and we have been advised to consult an attorney or tax advisor regarding the possible legal or tax implications of signing the Marathon Petroleum Certificationof Common Law Marriage.CertificationWe certify the information contained in this Marathon Petroleum Certificationof Common Law Marriageis true and correct and understand that a false declaration may result in termination of any benefit plan coverage under the terms of the employee’s employment with Marathon Petroleum Company. In the event of a false declaration, the Company and the respective benefit plans may recover damages for all costs and expenses incurred as a result of such false declaration, including, without beinglimited to, attorney’s fees incurred by the Company to recover such costs and expenses. I further understand that knowingly providing false information to the Company could result in employee disciplinary action, up to and including termination.Employee Signature: _______________________________________________Date: ____________________Common Law Spouse Signature: _____________________________________Date: ____________________This form and the Domestic Partner Certification should be submitted to the BenefitsolverEmployee Benefits Center Verification Department.BenefitsolverEmployee Benefits Center | Phone: 1Web: www.myMPCbenefits.com/mybenefits | FAX: 12246 | Emaildv@businessolver.com Marathon Petroleum Company LP | RM64995C18 | Revised 08/01/2020