Harriman, NY · Orange County
Affidavit of Exemption for Workers’ Compensation Coverage
This affidavit lets eligible owners of one- to four-family, owner-occupied residences certify an exemption from workers’ compensation coverage proof 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 affidavit is for an eligible homeowner listed as the general contractor on a building permit for an owner-occupied residence with one to four family units. The homeowner selects the applicable work or hiring condition, certifies the statement under penalty of perjury, and submits the notarized form to the government entity issuing the permit. The form says it cannot waive any party’s workers’ compensation rights or obligations.
Who needs it
A homeowner listed as general contractor may need this affidavit when applying for a building permit for an eligible owner-occupied, one- to four-family residence.
How to get this notarized
- 1
Download the BP-1
Get the BP-1 affidavit from the Village of Harriman and check that it is the correct form for your building permit.
- 2
Complete the Affidavit
Enter the requested homeowner and property information and select the statement that applies to your work and hiring situation.
- 3
Book an Online Notary
Schedule a remote session with a commissioned online notary and have the completed form ready.
- 4
- 5
Submit to the Permit-Issuing Entity
Provide the notarized BP-1 to the government entity issuing your building permit.
Preview the form
The blank PDF straight from Harriman. 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 BP-1 affidavit online?
- Complete the form, then meet with a commissioned online notary by video. Sign when directed so the notary can complete the “Sworn to before me” jurat.
- Do I need to sign the BP-1 in front of a notary?
- Yes. The form includes a “Sworn to before me” jurat, and the homeowner’s affidavit must be notarized before it is submitted to the government entity issuing the building permit.
- Can an online notary notarize this New York affidavit?
- New York authorizes remote online notarization by a commissioned online notary. You sign during a live video session, and the notary completes the jurat.
- Where do I submit the notarized BP-1?
- 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 Orange County cities
Each city publishes its own version of this form. Pick the city where you’re filing.