Lawson, MO · Clay County
Affidavit of Exemption for Workers’ Compensation Insurance
This affidavit lets a construction contractor state why the business is exempt from workers’ compensation insurance and is filed with a city or county when applying for an occupational or business license.
At a glance
- Issued by
- City of Lawson · Lawson, Clay County, Missouri
- Notarization
- Required: sign this form in front of a notary before filing it.
- Official source
- lawsonmo.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
The form is for construction contractors who apply for an occupational or business license without proof of workers’ compensation insurance coverage. The contractor identifies the business and selects an exemption reason, such as having no employees or qualifying for a corporate exemption. The form text says a contractor who submits it to obtain a license should review the attached statutory provisions and guidelines; failure to provide proof or complete the affidavit may result in denial of the license.
Who needs it
A construction contractor applying for an occupational or business license without proof of workers’ compensation coverage may need to file this affidavit with the city or county.
How to get this notarized
- 1
Download The Affidavit
Get the Affidavit of Exemption for Workers’ Compensation Insurance from the city’s form page.
- 2
Complete The Form
Enter the requested affiant and business information, select the applicable exemption reason, and gather any supporting document the form requires.
- 3
Book An Online Notary
Schedule a remote session with a commissioned online notary.
- 4
Take The Oath And Sign
Meet by live video, take the required oath, and sign as directed by the notary.
- 5
Submit The Affidavit
Send the notarized affidavit and any required supporting documents to the city or county with your license application.
Preview the form
The blank PDF straight from Lawson. 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
- Who uses this workers’ compensation affidavit?
- The form is for construction contractors applying for an occupational or business license who do not have proof of workers’ compensation insurance coverage and claim an exemption.
- How do I notarize the affidavit online?
- Complete the form, then meet with a commissioned online notary by live video. Take the oath and sign when instructed, and submit the completed affidavit and any required supporting document to the city or county.
- Do I need to take an oath before signing?
- Yes. The form says it must be subscribed and sworn before a notary, so the affiant must take an oath in the notary’s presence before signing.
- Does Missouri allow this affidavit to be notarized online?
- Missouri authorizes its own notaries to perform remote online notarizations under RSMo §486.1100 to §486.1205. Ask the receiving office whether it accepts an electronically notarized version; 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.