Florida, NY · Orange County
Workers’ Compensation Exemption Affidavit
This BP-1 affidavit lets an eligible owner of a one- to four-family, owner-occupied residence 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 is for a homeowner listed as the general contractor on a building permit for a one- to four-family, owner-occupied residence, including a condominium. The owner checks the applicable exemption condition, certifies the information under penalty of perjury, and signs before a notary. The form explains that homeowners paying workers a total of 40 or more hours per week must arrange coverage or have the general contractor provide proof instead.
Who needs it
A homeowner listed as general contractor on a building permit for an eligible owner-occupied residence may need this affidavit if one of its exemption conditions applies.
Why it needs a notary
The form has a “Sworn to before me” jurat; the homeowner who makes the certification must sign and swear to it before the notary.
How to get this notarized
- 1
Download The BP-1 Form
Get the Workers’ Compensation Exemption Affidavit and review its eligibility conditions.
- 2
Fill In The Form
Check the applicable condition and complete the homeowner and property information. Do not sign yet.
- 3
Book An Online Notary
Schedule a remote session with a commissioned online notary and prepare valid identification.
- 4
Sign On Video
Join the live video session, swear to the affidavit, and sign when instructed by the notary.
- 5
Submit To The Village
Provide the notarized BP-1 with your building permit application as directed by the permitting office.
Preview the form
The blank PDF straight from Florida. 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 form but wait to sign. Book a session with a commissioned online notary, show identification, and sign and swear to the affidavit during the live video session.
- Do I need to notarize this affidavit?
- Yes. The BP-1 includes a “Sworn to before me” jurat, so the homeowner making the certification must swear to and sign the form before a notary.
- Who can use this workers’ compensation exemption form?
- The form is for a homeowner listed as general contractor on a permit for a one- to four-family, owner-occupied residence who meets one of the listed conditions. It cannot be used to waive anyone’s workers’ compensation rights or obligations.
- Can a commissioned online notary notarize this form?
- New York authorizes its notaries to perform remote online notarizations under Executive Law §135-c, effective since 2023. Confirm with the city, town or village if unsure whether it will accept the notarized form.
Workers’ Compensation Exemption Affidavit in other Orange County cities
Each city publishes its own version of this form. Pick the city where you’re filing.