Freeport, IL · Stephenson County
Affidavit of Exemption from the Illinois Workers Compensation Act
This affidavit lets a business representative attest that the business is exempt from the Illinois Workers Compensation Act for its City of Freeport contractor license.
- 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
The affidavit records a representative’s sworn statement that a business is exempt from the Illinois Workers Compensation Act and understands the City of Freeport’s contractor requirements. The City requires licensed contractors to comply with the Act, and the signer agrees to provide proof of coverage if the business later becomes subject to it. The form also warns that failure to provide proof may lead to citations, fines, or license suspension or revocation.
Who needs it
A business representative seeking to document an exemption from the Illinois Workers Compensation Act for a City of Freeport contractor license needs this affidavit.
Why it needs a notary
The form has a subscribed-and-sworn jurat; the affiant signs the statement and swears to it before the notary public.
How to get this notarized
- 1
Download The Affidavit
Get the Affidavit of Exemption from the Illinois Workers Compensation Act from the City of Freeport.
- 2
Fill In Business Details
Enter the business name and form of business, and review the statements before signing.
- 3
Book An Online Notary
Schedule a remote session with a commissioned online notary.
- 4
Sign On Video
Sign and swear to the affidavit before the notary during the video session.
- 5
Submit To The City
Send the notarized affidavit to the City of Freeport Community Development Department.
Preview the form
The blank PDF straight from Freeport. 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 get this affidavit notarized online?
- Complete the business information, then book a session with a commissioned online notary. Sign and swear to the statement during the video session, then submit the notarized affidavit to the City.
- Do I need to sign the affidavit before meeting the notary?
- No. The form calls for the affiant to subscribe and swear to it before a notary public, so sign during the notarial session as directed.
- What does the business promise in this affidavit?
- The signer attests that the business is exempt and agrees to provide proof of coverage if it later becomes subject to the Act while licensed with the City.
- Can I use an online notary for this form?
- Illinois authorizes its notaries to perform electronic and remote notarizations under the Illinois Notary Public Act (5 ILCS 312), and recognizes acts performed outside Illinois by an officer authorized where the act occurs (765 ILCS 30). Confirm with the city or village if unsure.