Baxter Estates, NY · Nassau County
Affidavit of Exemption from Workers’ Compensation Insurance
This affidavit states that permit work will be done solely by the applicant, who claims exemption from workers’ compensation insurance, for a Village of Baxter Estates building permit application.
- 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 applicant swears that the work described in a building permit application will be done solely by them and that they are exempt from obtaining workers’ compensation insurance. The affidavit also states that if they later hire workers or subcontractors, they will obtain the necessary insurance and comply with applicable laws. The Village of Baxter Estates Building Department relies on these statements when issuing the permit.
Who needs it
An applicant for a Village of Baxter Estates building permit who states that they will perform the proposed work solely and are exempt from workers’ compensation insurance needs this affidavit.
Why it needs a notary
The form has a sworn-to jurat stating “Sworn to be before me”; the applicant or agent named as deponent signs the affidavit before a notary public.
How to get this notarized
- 1
Download the Affidavit
Get the Village of Baxter Estates Affidavit of Exemption from Workers’ Compensation Insurance.
- 2
Fill In the Form
Provide the permit and property details, describe the work, and complete the applicant information.
- 3
Book an Online Notary
Arrange a remote notarization with a commissioned online notary.
- 4
- 5
Submit to the Village
Submit the completed affidavit with your building permit application to the Village of Baxter Estates.
Preview the form
The blank PDF straight from Baxter Estates. 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 this affidavit?
- Enter the building permit number, property location and tax lot details, describe the proposed work, and complete the applicant and residence information. Sign before a notary.
- Do I need to sign this form in front of a notary?
- Yes. The form includes a sworn-to jurat, so the applicant or agent must sign the affidavit before a notary public.
- Can I sign the affidavit with an online notary?
- A commissioned online notary can conduct a remote notarization by video. Confirm with the city, town or village if unsure whether it will accept your remotely notarized form.
- What if I hire workers or subcontractors after applying?
- The affidavit states that if workers or subcontractors become necessary during construction, the applicant will obtain the necessary workers’ compensation insurance and comply with applicable laws.
Other forms in Baxter Estates
Affidavit of Final Cost of Construction
Baxter Estates
Affidavit in Lieu of Current Survey
Baxter Estates
Amendment to Application for Building Permit
Baxter Estates
Board of Zoning Appeals Application
Baxter Estates
Building Permit Application
Baxter Estates
Affidavit of Homeowner as Self-Contractor
Baxter Estates
Affidavit of Exemption from Workers’ Compensation Insurance in other Nassau County cities
Each city publishes its own version of this form. Pick the city where you’re filing.