Village of Pawling, NY · Dutchess County
Affidavit of Exemption for Workers’ Compensation Coverage
This affidavit lets eligible homeowners of one- to four-family owner-occupied residences certify an exemption from workers’ compensation coverage 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 eligible homeowner 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 exemption basis, certifies the information under penalty of perjury, and agrees to provide coverage or other proof if the project’s paid work reaches 40 hours or more per week. The form states that it serves as an exemption for workers’ compensation and disability benefits coverage once notarized.
Who needs it
A homeowner applying for a building permit in Pawling may need this affidavit if they are the general contractor for an eligible owner-occupied residence and meet one of its exemption conditions.
Why it needs a notary
The supplied form text has no printed jurat or acknowledgment block; the homeowner signs the affidavit before a notary so it can be notarized.
How to get this notarized
- 1
Download the Affidavit
Get the BP-1 Affidavit of Exemption for your building permit application.
- 2
Complete the Form
Enter the homeowner and property information, and check the exemption condition that applies.
- 3
Book an Online Notary
Schedule a remote session with a commissioned online notary.
- 4
Sign on Video
Sign the affidavit during the online notary appointment.
- 5
Submit to the Village
Include the notarized affidavit with your building permit application.
Preview the form
The blank PDF straight from Village of Pawling. 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 the BP-1 affidavit notarized online?
- Complete the affidavit, book a session with a commissioned online notary, and sign during the video appointment. Submit the notarized form with your building permit application.
- Do I need to notarize this affidavit?
- Yes. The form states that once notarized, the BP-1 serves as an exemption for workers’ compensation and disability benefits insurance coverage.
- Who can use this workers’ compensation exemption affidavit?
- The form is for a homeowner of a one- to four-family owner-occupied residence, including a condominium, who is listed as the general contractor and meets one of the stated conditions.
- What if I expect paid work to reach 40 hours per week?
- The form says that if paid work totals 40 hours or more per week, the homeowner must arrange appropriate coverage or have the general contractor provide appropriate proof of coverage or exemption.
- Where do I submit the notarized form?
- Submit it with your building permit application to the permit-issuing government entity. Confirm with the city, town or village if unsure about submission requirements.
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.