Newstead, NY · Erie County
Homeowner Affidavit of Exemption
Homeowners applying for a building permit use this affidavit to claim an exemption from showing workers’ compensation insurance proof for qualifying work.
What this form is
This affidavit lets a homeowner of a one- to four-family owner-occupied residence, including a condominium, state why they are not required to show workers’ compensation insurance proof with a building permit application. It asks the homeowner to select the applicable exemption, certify the circumstances, and provide a signature, date, telephone number, property address, and printed name. The form describes requirements for paid work totaling less than or at least 40 hours per week.
Who needs it
A homeowner applying for a building permit for a one- to four-family owner-occupied residence who claims an exemption from showing workers’ compensation proof may use this affidavit.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This affidavit is signed and dated without a notary; it refers to the building permit, but does not identify any attachment or related step that must be notarized or sworn.
How to submit this form
- 1
Download The Affidavit
Download the Homeowner Affidavit of Exemption PDF.
- 2
Complete The Form
Select the applicable exemption, certify the circumstances, and fill in the requested homeowner and property details.
- 3
Gather The Building Permit
The form refers to the building permit for the property; have the permit information available.
- 4
Sign And Submit
Sign and date the affidavit, then submit it to the city department named on the form.
Frequently asked questions
- Do I need a notary for the Homeowner Affidavit of Exemption?
- No. The affidavit has signature and date fields but no notary block. It refers to the building permit, with no notarized attachment or related step specified.
- Who uses the Homeowner Affidavit of Exemption?
- A homeowner applying for a building permit for a one- to four-family owner-occupied residence, including a condominium, may use it to state why they are exempt from showing workers’ compensation proof.
- What information does the affidavit ask for?
- It asks the homeowner to select the applicable exemption and provide a signature, date, home telephone number, property address, and printed name.
- How do I submit the Homeowner Affidavit of Exemption?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Homeowner Affidavit of Exemption doesn’t need a notary — but if you have another Newstead form that does, a commissioned online notary can help.