Deerpark, NY · Orange County
Affidavit of Exemption for Workers’ Compensation Coverage
This affidavit lets an owner of a one- to four-family, owner-occupied residence explain why workers’ compensation coverage proof is not required for work covered by a Town of Deerpark 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 applying for a building permit for a one- to four-family, owner-occupied residence, including a condominium. The owner certifies that a stated exemption applies, such as doing all the work or meeting the form’s conditions for paid workers, and agrees to provide coverage proof or an exemption if circumstances require it. Once notarized, the form states that it serves as an exemption for workers’ compensation and disability insurance coverage.
Who needs it
A homeowner applying for a Town of Deerpark building permit for an owner-occupied one- to four-family residence may use this form if one of its exemption conditions applies.
Why it needs a notary
The form has a sworn-to-before-me jurat block; the homeowner who makes the affidavit signs before a notary public or county clerk.
How to get this notarized
- 1
Download The Affidavit
Get the Town of Deerpark BP-1 Affidavit of Exemption for your building permit application.
- 2
Review And Complete The Form
Select the exemption that applies and enter the homeowner and property details requested.
- 3
Book An Online Notary
Schedule a session with a commissioned online notary before signing the affidavit.
- 4
Sign On Video
Show identification and sign during the live video session when directed by the notary.
- 5
Submit To The Town
Submit the notarized BP-1 with your building permit materials.
Preview the form
The blank PDF straight from Deerpark. 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 notarize the Deerpark BP-1 affidavit online?
- Complete the affidavit, then book with a commissioned online notary. Sign during the video session when instructed, and submit the notarized form with your building permit materials.
- Do I need to notarize this workers’ compensation exemption form?
- Yes. The BP-1 includes a sworn-to-before-me block for a notary public or county clerk, and the homeowner making the affidavit signs before that official.
- Can I use this affidavit if I hire workers?
- The form lists conditions for paid workers, including limits on aggregate weekly hours and an active homeowners policy. Read the choices and related commitments carefully to determine whether one applies.
- Can I sign this form with a remote online notary?
- New York authorizes remote online notarization under Executive Law §135-c. A commissioned online notary can notarize the affidavit in a video session; confirm with the city, town or village if unsure.
Affidavit of Exemption for Workers’ Compensation Coverage in other Orange County cities
Each city publishes its own version of this form. Pick the city where you’re filing.