North East, NY · Dutchess County
Affidavit of Exemption for Workers’ Compensation Coverage
This affidavit lets an owner of a one- to four-family owner-occupied residence report an exemption from workers’ compensation coverage requirements when applying for a building permit.
- 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 BP-1 affidavit is for an owner listed as the general contractor on a building permit for a one- to four-family owner-occupied residence, including a condominium. The homeowner checks the applicable reason for exemption and certifies it under penalty of perjury. The form says it serves as an exemption for workers’ compensation and disability benefits insurance coverage once notarized; it also describes other coverage or exemption proof that may be needed when paid work reaches 40 hours or more per week.
Who needs it
A homeowner listed as general contractor on a building permit for an owner-occupied residence of one to four families may file this affidavit if one of its exemption conditions applies.
Why it needs a notary
The supplied form text shows no printed jurat or acknowledgment block; the homeowner signs the affidavit and must have the signature notarized for it to serve as an exemption.
How to get this notarized
- 1
Download the BP-1 Form
Get the BP-1 Affidavit of Exemption for Workers’ Compensation Coverage.
- 2
Complete the Form
Enter the homeowner and property details, then check the exemption condition that applies.
- 3
Book an Online Notary
Schedule a remote notarization with a commissioned online notary.
- 4
Sign on Video
Sign the affidavit during the online notary session.
- 5
Submit to the Permit Issuer
Send the notarized form to the government entity issuing the building permit.
Preview the form
The blank PDF straight from North East. 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 can use the BP-1 affidavit?
- The form is for an owner of a one- to four-family owner-occupied residence, including a condominium, who is listed as general contractor on the building permit and meets one of the stated exemption conditions.
- How do I complete and submit this affidavit?
- Select the exemption condition that applies, complete the homeowner and property details, sign before a commissioned online notary, then submit the notarized form to the government entity issuing the building permit.
- Do I need to notarize the BP-1 form?
- Yes. The form states that once notarized, it serves as an exemption for workers’ compensation and disability benefits insurance coverage.
- What if paid work reaches 40 hours per week?
- The form says the homeowner must obtain appropriate workers’ compensation coverage and provide proof, or have the general contractor provide proof of coverage or exemption, when paid individuals total 40 or more hours per week.
- Can I use remote online notarization for this form?
- New York authorizes remote online notarization by a commissioned online notary under Executive Law §135-c. Confirm with the city, town or village if unsure whether it will accept the notarized form.
Other forms in North East
Affidavit of Exemption for Workers’ Compensation Coverage in other Dutchess County cities
Each city publishes its own version of this form. Pick the city where you’re filing.