Kingston, NY · Ulster County
Homeowners Workers’ Compensation Exemption Affidavit
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 the building permit being requested.
- 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 checks the applicable reason for not providing specific proof of workers’ compensation coverage, such as doing the work personally or having an active homeowners policy while paying workers less than 40 aggregate hours per week. The form also describes what coverage proof or exemption must be provided if work reaches 40 or more aggregate paid hours per week. It is for the homeowner applying for a building permit for the listed property.
Who needs it
A homeowner applying for a building permit for an owner-occupied one- to four-family residence may use this affidavit to state why specific workers’ compensation coverage proof is not required.
Why it needs a notary
The form carries a “Sworn to before me” jurat, so the homeowner signs the affidavit before a notary public.
How to get this notarized
- 1
Download The Affidavit
Get the homeowners workers’ compensation exemption affidavit from the City of Kingston.
- 2
Complete The Form
Enter the property and homeowner information, then check the reason that applies to the work and coverage.
- 3
Book An Online Notary
Schedule an online notarization with a commissioned online notary.
- 4
- 5
Submit To The City
Send the notarized form with your building permit materials to the government entity issuing the permit.
Preview the form
The blank PDF straight from Kingston. 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 this homeowners exemption affidavit online?
- Complete the form, book with a commissioned online notary, and sign during the video session. The notary completes the “Sworn to before me” jurat.
- Do I need to sign the affidavit in front of a notary?
- Yes. The form includes a “Sworn to before me” jurat, so the homeowner must sign before a notary public.
- What does this affidavit say about workers’ compensation coverage?
- It lets the homeowner state a listed reason for not providing specific coverage proof and describes coverage or exemption proof to provide if paid work reaches 40 aggregate hours per week.
- Can I use remote online notarization for this form?
- New York authorizes its notaries to perform remote online notarizations under Executive Law §135-c. Ask the city whether it will accept the notarized form for your building permit.
- Where should I submit the notarized form?
- The form refers to the government entity issuing the building permit. Submit it with your permit materials and confirm with the city, town or village if unsure.
Homeowners Workers’ Compensation Exemption Affidavit in other New York cities
Each city publishes its own version of this form. Pick the city where you’re filing.