Newton, KS · Harvey County
Certification of Exemption From Workers Compensation Insurance Requirements
This certification lets an applicant for a City of Newton license declare that they have no employees and are not subject to workers compensation insurance requirements under Kansas law.
- 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 applicant certifies that they have no employees in the trade and are not subject to workers compensation insurance requirements. The form accompanies an application for a City of Newton license. It also states that if the license holder later employs anyone in the trade, they must acquire the required insurance and promptly provide proof to the City Clerk; failure to do so may violate city ordinances and provide grounds for license revocation.
Who needs it
A person applying for a City of Newton license who has no employees in the trade and certifies they are not subject to workers compensation insurance requirements needs this form.
Why it needs a notary
The applicant signs the form before a notary, who completes the “Subscribed and sworn to before me” jurat and records the commission expiration.
How to get this notarized
- 1
Download the Form
Download the workers compensation exemption certification from the City of Newton.
- 2
Complete the Certification
Enter your name, business name if applicable, and the license classification; review the certification before signing.
- 3
Book an Online Notary
Schedule an online notarization with a commissioned online notary.
- 4
Sign on Video
Sign and swear to the certification during the video session so the notary can complete the jurat.
- 5
Submit to the City
Send the notarized form with all supporting documentation to the City of Newton; the form lists [email protected] for email submission.
Preview the form
The blank PDF straight from Newton. 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 this workers compensation exemption form online?
- Complete the certification, then meet with a commissioned online notary by video. Sign during the session when directed so the notary can complete the form’s jurat. Submit the notarized form with your supporting documents to the City of Newton.
- Do I need to sign this form in front of a notary?
- Yes. The form includes a “Subscribed and sworn to before me” jurat, so the applicant must sign and swear to the certification before a notary completes that section.
- Can I use an online notary for this form?
- Kansas authorizes remote online notarization by its notaries under K.S.A. 53-5a15, and K.S.A. 53-5a11 recognizes notarial acts by authorized officers of another state. Confirm with the city if unsure whether it will accept your notarized form.
- How do I submit the completed application?
- The form says applications with all supporting documentation may be emailed to [email protected]. Include the completed, notarized certification with the application materials.