Wethersfield, CT · Hartford County
Statement Regarding Workers’ Compensation Insurance Affidavit
This Wethersfield form lets a property owner or building permit applicant state how workers’ compensation coverage will be provided for employees and workers on a construction project.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
Wethersfield’s form is for a building permit request involving work at a property. It asks the owner or applicant to identify their role and indicate whether they will provide workers’ compensation coverage or require proof of coverage from contractors, subcontractors, and other workers before work begins. The affidavit option is for an owner or sole proprietor who will not personally submit proof but attests to requiring that proof from everyone working on the project.
Who needs it
A property owner or building permit applicant completing the workers’ compensation statement for construction work at a Wethersfield property needs this form.
How to get this notarized
- 1
Download the Form
Get the Statement Regarding Workers’ Compensation Insurance Affidavit from Wethersfield.
- 2
Complete the Form
Enter the property and applicant information, choose the applicable statement, and complete the affidavit if using that option.
- 3
Book an Online Notary
Schedule a remote notarization session for the affidavit section.
- 4
Sign on Video
Sign the affidavit during the video session in front of a commissioned online notary.
- 5
Submit to Wethersfield
Submit the completed form with your building permit materials according to the town’s instructions.
Preview the form
The blank PDF straight from Wethersfield. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I notarize the workers’ compensation affidavit online?
- Complete the form, then book a session with a commissioned online notary. Sign the affidavit during the video session and submit the notarized form to Wethersfield.
- Do I need to notarize every section of this form?
- The form’s notary block follows the affidavit. If you choose that option, the owner or sole proprietor making the sworn attestation signs before the notary.
- Can a commissioned online notary notarize this affidavit?
- Connecticut authorizes its own notaries to perform online notarizations under Public Act 23-28, effective October 1, 2023. Conn. Gen. Stat. §1-57 recognizes qualifying notarial acts performed outside Connecticut.
- Where do I submit the completed form?
- The form concerns a building permit request in Wethersfield. Follow the town’s submission instructions; confirm with the town clerk if unsure.