Bethel Park, PA · Allegheny County
Affidavit of Exemption for Workers’ Compensation
This affidavit lets a residential building permit applicant or contractor explain why workers’ compensation coverage is exempt for a project in Bethel Park.
- 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
Bethel Park’s residential building permit application includes this affidavit for applicants or contractors claiming an exemption from workers’ compensation coverage. The signer selects and explains the basis for exemption, provides applicant and company details, and verifies the statements under oath. The form also addresses subcontractor coverage and the applicant’s responsibility to follow the Workers’ Compensation Act while work is performed under the permit.
Who needs it
A residential building permit applicant or contractor claiming a workers’ compensation exemption for a Bethel Park project needs to complete this affidavit.
How to get this notarized
- 1
Download the Affidavit
Get Bethel Park’s Affidavit of Exemption for Workers’ Compensation.
- 2
Fill Out the Form
Provide applicant and company details, select the exemption basis, and explain it where requested.
- 3
Book an Online Notary
Schedule a session with a commissioned online notary and have identification ready.
- 4
- 5
Submit to the City
Include the notarized affidavit with your residential building permit application to Bethel Park.
Preview the form
The blank PDF straight from Bethel Park. 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 workers’ compensation exemption affidavit?
- Enter the applicant and company details, select and explain the applicable exemption basis, then sign the verification under oath before a notary. Submit it with the residential building permit application.
- Do I need to notarize this affidavit?
- Yes. The form includes a “Subscribed and sworn to before me” jurat, so the applicant or contractor must sign under oath before a notary completes the jurat.
- Can I use an online notary for this form?
- Pennsylvania permits remote online notarization by a commissioned online notary. Check that Bethel Park will accept an online-notarized affidavit for your application; confirm with the city, borough or township if unsure.
- Who should complete this affidavit?
- The applicant or contractor seeking a workers’ compensation exemption for work under a Bethel Park residential building permit should complete and sign the affidavit.
Affidavit of Exemption for Workers’ Compensation in other Allegheny County cities
Each city publishes its own version of this form. Pick the city where you’re filing.