Columbia, MO · Boone County
Affidavit of Exemption for Workers’ Compensation Insurance
This affidavit lets a construction-industry contractor without workers’ compensation coverage state why the business is exempt when applying for an occupational or business license from a city or county.
At a glance
- Issued by
- City of Columbia · Columbia, Boone County, Missouri
- Notarization
- Required: sign this form in front of a notary before filing it.
- Official source
- como.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
- 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
A contractor in the construction industry uses this form to explain why the business is not required to carry workers’ compensation insurance. The form says it must be filed when applying for a city or county occupational or business license if the contractor cannot provide proof of coverage. It asks the affiant to select an exemption reason, make statements about the business and its employees, and swear that the information is true.
Who needs it
A construction-industry contractor applying for a Columbia occupational or business license may need this affidavit if they cannot provide proof of workers’ compensation insurance coverage.
How to get this notarized
- 1
Download the Affidavit
Get the Affidavit of Exemption for Workers’ Compensation Insurance form.
- 2
Complete the Form
Enter the affiant and business information, select the applicable exemption reason, and review the statements.
- 3
Book an Online Notary
Schedule a remote session with a commissioned online notary.
- 4
Sign and Swear on Video
Sign the affidavit and swear to its statements in front of the notary during the video session.
- 5
Submit with Your Application
Submit the notarized affidavit with your occupational or business license application as directed by the city.
Preview the form
The blank PDF straight from Columbia. 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 affidavit online?
- Complete the form but wait to sign. Book a session with a commissioned online notary, show identification, and sign and swear to the affidavit during the video session.
- Do I need to file this form with my license application?
- The form says a construction-industry contractor applying for an occupational or business license must file it if they do not have proof of workers’ compensation coverage. Confirm with the city or town if unsure.
- Who should complete the affidavit?
- The form is for a contractor in the construction industry who is applying for a city or county occupational or business license without proof of workers’ compensation coverage and claims an exemption.
- Can I swear to the affidavit through an online notary?
- Missouri authorizes remote online notarization by its own notaries. Ask the receiving office whether it accepts this affidavit notarized online before submitting it.
Affidavit of Exemption for Workers’ Compensation Insurance in other Missouri cities
Each city publishes its own version of this form. Pick the city where you’re filing.