Walworth, NY · Wayne County
Homeowners Workers’ Compensation Exemption Affidavit
This BP-1 affidavit lets eligible owners of one- to four-family owner-occupied homes 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 an owner listed as the general contractor on a building permit for a one- to four-family owner-occupied residence, including a condominium. The homeowner checks the applicable basis for exemption, provides property and contact details, and signs the affidavit. Walworth requires it when an eligible homeowner applies for a building permit and uses the form to document the stated workers’ compensation and disability benefits insurance exemption; it cannot waive any party’s workers’ compensation rights or obligations.
Who needs it
A homeowner listed as general contractor on a building permit for an owner-occupied one- to four-family residence may need this form if one of its exemption conditions applies.
Why it needs a notary
The form states it serves as an exemption once notarized, but the provided text shows no separate jurat or acknowledgment block; the homeowner signs the affidavit.
How to get this notarized
- 1
Download the BP-1
Get the BP-1 homeowners affidavit for your building permit application.
- 2
Fill In the Form
Select the applicable exemption condition and enter the homeowner, contact, and property details.
- 3
Book an Online Notary
Schedule a remote session with a commissioned online notary.
- 4
Sign on Video
Sign the affidavit during the online video session and complete notarization.
- 5
Submit to the Town
Submit the notarized BP-1 with your building permit application.
Preview the form
The blank PDF straight from Walworth. 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 complete and submit the Walworth BP-1?
- Choose the exemption condition that applies, complete the homeowner and property details, sign before a notary, then submit the notarized form with your building permit application.
- Do I need to notarize the BP-1 form?
- Yes. The form states that once notarized, it serves as an exemption for workers’ compensation and disability benefits insurance coverage.
- Can I sign this form with a commissioned online notary?
- New York authorizes remote online notarization by a commissioned online notary under Executive Law §135-c. Sign during the online video session, and confirm with the city, town or village if unsure.
- Who can use this homeowners exemption affidavit?
- The form is for a homeowner listed as general contractor on a permit for an owner-occupied one- to four-family residence who meets one of the listed conditions. It cannot be used to waive any party’s workers’ compensation rights or obligations.
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.