Mebane, NC · Alamance County
Workers Compensation Affidavit
This affidavit records workers’ compensation coverage and contractor or owner statements for a Mebane building permit, and is completed by the permit applicant, contractor, owner, or authorized agent.
- 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 form asks the building permit applicant to state whether workers’ compensation coverage applies to the people performing the permitted work and includes separate license-status statements for contractors and owners. Mebane’s Inspections Department may request proof of coverage before issuing a permit or while permitted work is underway. The owner or applicant section also includes a sworn statement and notary block.
Who needs it
A building permit applicant, contractor, owner, or authorized agent completing the workers’ compensation and license-status statements for work covered by a Mebane permit needs this form.
Why it needs a notary
The form has a jurat, marked “Sworn to and subscribed before me”; the owner or applicant signs the sworn statement before the notary.
How to get this notarized
- 1
Download the Form
Get the City of Mebane workers’ compensation form and review the applicant, contractor, and owner sections.
- 2
Complete the Applicable Statements
Fill in the permit and business details, select the applicable coverage statement, and complete the relevant license-status section.
- 3
Book an Online Notary
Arrange a session with a commissioned online notary and confirm with the city that it will accept the notarization.
- 4
Sign on Video
Sign the sworn owner or applicant statement during the notarization session.
- 5
Submit to the City
Submit the completed affidavit with your building permit materials and provide coverage certificates if requested.
Preview the form
The blank PDF straight from Mebane. 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 the Mebane workers’ compensation affidavit?
- Complete the applicable applicant, contractor, or owner statements, then sign the sworn statement before a notary. Submit the completed form with your building permit materials.
- Do I need to sign this form in front of a notary?
- Yes. The owner or applicant statement ends with a “Sworn to and subscribed before me” jurat and a space for the notary’s signature and commission expiration.
- Can I use an online notary for this form?
- North Carolina’s enacted remote electronic notarization program has not launched. Emergency video notarization requires the signer and notary to be in North Carolina and is not remote online notarization. Ask the city whether it will accept a notarization by a commissioned online notary; confirm with the city or town if unsure.
- What should I provide with the affidavit?
- The form says the Inspections Department may require certification of workers’ compensation coverage before issuing a permit and during permitted work. Submit certificates when requested by the building inspector.
Other forms in Mebane
Workers Compensation Affidavit in other North Carolina cities
Each city publishes its own version of this form. Pick the city where you’re filing.