Lake Winnebago, MO · Cass County
Affidavit of Exemption for Workers’ Compensation Insurance
This affidavit lets a construction business owner or partner declare an exemption from workers’ compensation insurance when submitting it to a city or county for a contractor occupational or business license.
At a glance
- Issued by
- City of Lake Winnebago · Lake Winnebago, Cass County, Missouri
- Notarization
- Required: sign this form in front of a notary before filing it.
- Official source
- cityoflakewinnebago.com
- 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 construction business owner or partner uses this affidavit to state why the business is exempt from carrying workers’ compensation insurance, such as having no employees or qualifying for a corporate exemption. The form says to submit it to the city or county when applying for an occupational or business license as a contractor in the construction industry. The affiant also swears to the statements about the business and statutory employment.
Who needs it
A sole proprietor, business owner, or partner in construction who is claiming an exemption when applying for a contractor occupational or business license needs this affidavit.
How to get this notarized
- 1
Download the Affidavit
Get the Workers’ Compensation Insurance Exemption Affidavit from the city’s form source.
- 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 on Video
Show identification, swear to the affidavit, and sign during the online notary session.
- 5
Submit to the City
Submit the notarized affidavit to the city or county with the contractor license application.
Preview the form
The blank PDF straight from Lake Winnebago. 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 affidavit, then book a session with a commissioned online notary. Sign and swear to the statements during the video session, and submit the notarized form with your license application.
- Do I need to sign the affidavit in front of a notary?
- Yes. The form includes a subscribed-and-sworn jurat, so the affiant must swear to the statements and sign before the notary completes the notarial section.
- Can this affidavit be notarized remotely?
- Missouri law authorizes remote online notarization by Missouri notaries under RSMo §486.1100 to §486.1205. Use a commissioned online notary and confirm the receiving office accepts the notarized document.
- Where do I submit the completed form?
- The form says it may be submitted to the city or county for an occupational or business license as a construction contractor. Confirm the destination and any filing instructions with the licensing office; confirm with the city or town if unsure.
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.