Prattsville, NY · Greene County
Affidavit of Exemption for Workers’ Compensation Coverage
This affidavit lets an owner of a one- to four-family, owner-occupied residence explain why specific workers’ compensation coverage proof is not required 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 homeowner certifies under penalty of perjury that a listed exemption applies, such as doing all the work personally, hiring no one, or paying workers fewer than 40 aggregate hours per week while maintaining homeowner’s insurance. The form also describes coverage or exemption documentation that may be needed if the project reaches 40 or more aggregate paid-worker hours per week. Submit the notarized BP-1 to the government entity issuing the building permit.
Who needs it
A homeowner applying for a building permit for a one- to four-family, owner-occupied residence may use this form to claim an applicable workers’ compensation coverage exemption.
Why it needs a notary
The form has a “Sworn to before me” jurat block; the homeowner signs the certification before the notary and provides their printed name and property details.
How to get this notarized
- 1
Download the BP-1
Get the Affidavit of Exemption to Show Specific Proof of Workers’ Compensation Insurance Coverage.
- 2
Complete the Affidavit
Enter the homeowner and property details and select the exemption that applies to your situation.
- 3
Book an Online Notary
Schedule a remote session with a commissioned online notary before signing.
- 4
- 5
Submit to the Permit Issuer
Send the notarized BP-1 to the government entity issuing your building permit.
Preview the form
The blank PDF straight from Prattsville. 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 submit the BP-1 affidavit?
- Complete and sign the affidavit before a notary, then submit the notarized form to the government entity issuing your building permit.
- Do I need to notarize this affidavit?
- Yes. The form includes a “Sworn to before me” block, so the homeowner must take the certification before a notary.
- Can I sign this form with a commissioned online notary?
- New York authorizes remote online notarization by a commissioned online notary under Executive Law §135-c. You can sign during a live online session.
- Which exemption can I claim?
- The form lists doing all the work yourself, hiring or paying no one, or having current homeowner’s insurance and paying workers fewer than 40 aggregate hours per week. Check the option that applies to you.
- Where do I file the notarized affidavit?
- The form says to provide it to the government entity issuing the building permit. Confirm with the city, town or village if unsure.
Affidavit of Exemption for Workers’ Compensation Coverage in other New York cities
Each city publishes its own version of this form. Pick the city where you’re filing.