Independence, KY · Kenton County
Affidavit of Assurances
The Affidavit of Assurances is a sworn statement for an applicant submitting a City of Independence permit application involving contractors or subcontractors on a 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
The applicant states that contractors and subcontractors employed or expected to work on the referenced project will comply with Kentucky workers’ compensation insurance and unemployment insurance requirements. The form asks for the permit number and project address, then requires the applicant’s signature before a notary. Use it when submitting the applicable permit materials to the City of Independence.
Who needs it
An applicant for the referenced City of Independence project must complete this form when contractors or subcontractors are employed or will be employed on the project.
Why it needs a notary
The applicant signs and swears to the statement before the notary, who completes the subscribed-and-sworn jurat and records commission expiration.
How to get this notarized
- 1
Download the Form
Get the Affidavit of Assurances from the City of Independence.
- 2
Fill In the Details
Add the permit number and project address, then complete the applicant statement.
- 3
Book an Online Notary
Arrange a remote session with a commissioned online notary.
- 4
Sign on Video
Sign and swear to the statement during the notary session.
- 5
Submit to the City
Send the notarized affidavit with the applicable permit materials to the City of Independence.
Preview the form
The blank PDF straight from Independence. 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 complete the Affidavit of Assurances?
- Enter the permit number and project address, complete the applicant statement, and sign before a notary. Then submit the notarized form with the applicable permit materials to the City of Independence.
- Do I need to sign this form in front of a notary?
- Yes. The form says the applicant must subscribe and swear to the statement before a notary public, who completes the jurat and commission-expiration information.
- Can I use an online notary for this affidavit?
- Kentucky authorizes its notaries to perform online notarizations after registering as an online notary public under KRS 423.355. A commissioned online notary can notarize your signature remotely.
- What requirements does the affidavit address?
- The applicant states that contractors and subcontractors on the project will comply with the Commonwealth of Kentucky’s workers’ compensation insurance and unemployment insurance requirements.
- Where do I submit the completed affidavit?
- The form is for a City of Independence permit project. Confirm with the city or county clerk if unsure which permit materials to include or where to submit them.
Other forms in Independence
Affidavit of Assurances in other Kentucky cities
Each city publishes its own version of this form. Pick the city where you’re filing.