Carl Junction, MO · Jasper County
Affidavit of Exemption for Workers’ Compensation Insurance
This affidavit lets a construction-industry business owner or partner state an exemption from workers’ compensation insurance when applying to a city or county for an occupational or business license.
At a glance
- Issued by
- City of Carl Junction · Carl Junction, Jasper County, Missouri
- Notarization
- Required: sign this form in front of a notary before filing it.
- Official source
- carljunction.org
- 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 affidavit is for a contractor in the construction industry who states that their business is exempt from carrying workers’ compensation insurance. It identifies possible reasons for exemption, including having no employees or, for certain corporations, having filed an employer’s exemption notice with the Missouri Division of Workers’ Compensation. The form says it is submitted to a city or county for an occupational or business license; confirm with Carl Junction if you are unsure whether it is required for your application.
Who needs it
A construction-industry sole proprietor, partner, or qualifying corporation owner may submit this affidavit when seeking an occupational or business license from a city or county.
How to get this notarized
- 1
Download the Affidavit
Get the workers’ compensation exemption affidavit from the city’s form page.
- 2
Fill In the Form
Provide the affiant and business details and check the applicable exemption reason.
- 3
Book an Online Notary
Arrange a remote notarization with a commissioned online notary.
- 4
Sign on Video
Sign and swear to the affidavit during the online notary session.
- 5
Submit the Affidavit
Include the notarized form with your occupational or business license application.
Preview the form
The blank PDF straight from Carl Junction. 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 workers’ compensation exemption affidavit?
- Enter the affiant and business information, select the applicable exemption reason, and complete the affidavit before a notary. Submit it with your license application; confirm with the city or town if unsure.
- Do I need to sign this affidavit before a notary?
- Yes. The form includes a state-and-county jurat stating that the affidavit was subscribed and sworn to before a notary public.
- Can I use a commissioned online notary for this form?
- Missouri authorizes its notaries to perform remote online notarizations under RSMo §486.1100 to §486.1205. Check that the city or county accepting your application will accept the notarized form.
- Who is this affidavit for?
- It is for a construction-industry contractor who states that their business is exempt from workers’ compensation insurance when applying to a city or county for an occupational or business license.
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.