Hudson Falls, NY · Washington County
Workers’ Compensation Exemption Affidavit
This affidavit lets eligible homeowners document an exemption from workers’ compensation coverage when applying for a building permit for an owner-occupied residence.
What this form is
The BP-1 affidavit is for owners of one- to four-family, owner-occupied residences who qualify for an exemption while applying for a building permit. It asks the homeowner to identify the basis for the exemption and provide a signature, date, telephone number, name, and property address. The document also explains coverage requirements when paid work reaches 40 hours or more per week.
Who needs it
A homeowner applying for a building permit for an owner-occupied residence may use this affidavit if one of the listed exemption conditions applies.
How to submit it
Submit the affidavit to the government entity issuing the building permit, as stated in the document.
About notarization
This document is signed without a notary; its text says that once notarized, BP-1 serves as an exemption, but it provides no notary block.
How to submit this form
- 1
Download The Affidavit
Download the Workers’ Compensation Exemption Affidavit PDF.
- 2
Complete The Form
Select the applicable exemption condition and enter the requested homeowner and property details.
- 3
Sign And Date
Sign and date the affidavit.
- 4
Submit With The Permit Application
Submit the affidavit to the government entity issuing the building permit.
Frequently asked questions
- Do I need a notary for the Workers’ Compensation Exemption Affidavit?
- No. This document has no notary block. Its text says that once notarized, BP-1 serves as an exemption, but does not provide a notary section.
- Who can use the Workers’ Compensation Exemption Affidavit?
- It is for homeowners of one- to four-family, owner-occupied residences applying for a building permit who meet one of the exemption conditions listed on the form.
- How do I submit the Workers’ Compensation Exemption Affidavit?
- Submit it to the government entity issuing the building permit.
Need something notarized?
This Workers’ Compensation Exemption Affidavit doesn’t need a notary — but if you have another Hudson Falls form that does, a commissioned online notary can help.