Franklin Park, PA · Allegheny County
Workers’ Compensation Exemption Affidavit
This affidavit lets a contractor or property owner explain why workers’ compensation insurance is not required and is submitted with a Franklin Park building permit application when applicable.
- 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
Franklin Park requires contractors to submit a current workers’ compensation insurance certificate with each permit application. Contractors without employees must instead complete this exemption affidavit, select the applicable reason, and provide the requested applicant information. The form also describes requirements for property owners performing their own work and religious exemptions. Homeowners applying for permits are exempt from these requirements. The Borough states that it accepts only an original paper document signed and sealed, not an electronic document.
Who needs it
Contractors without employees, qualifying property owners, or contractors claiming a religious exemption submit this affidavit with a Franklin Park building permit application.
Why it needs a notary
The form includes a subscribed, sworn-to, and acknowledged-before-me block; the applicant signs before the notary, who completes the notarial section and seal.
How to get this notarized
- 1
Download the Affidavit
Get the Workers’ Compensation Exemption Affidavit from Franklin Park’s building permit resources.
- 2
Fill In the Form
Select the applicable exemption reason and enter the applicant’s name, address, and telephone number.
- 3
Confirm Notarization Format
The form requires an original paper document signed and sealed. Check with Franklin Park before arranging online notarization.
- 4
Book an Online Notary
If the Borough confirms online notarization is acceptable, book a session with a commissioned online notary.
- 5
Sign Before the Notary
Follow the notary’s instructions and sign during the notarial session.
- 6
Submit to the City
Submit the completed affidavit with the building permit application as directed by Franklin Park.
Preview the form
The blank PDF straight from Franklin 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 this workers’ compensation affidavit?
- Select the exemption reason that applies, provide the applicant information, and sign before a notary. Franklin Park says it accepts only an original paper document signed and sealed.
- Do I need to submit this affidavit with my permit application?
- Contractors without employees must complete the affidavit. Contractors generally submit a current workers’ compensation insurance certificate; homeowners applying for permits are exempt from these requirements.
- Can I use a commissioned online notary for this form?
- Pennsylvania authorizes remote online notarization for its notaries, but Franklin Park’s form says electronic documents are not accepted. Confirm with the city, borough or township if unsure before booking.
- Who signs the affidavit before the notary?
- The applicant signs the affidavit and completes the applicant information section. The notary completes the subscribed, sworn-to, and acknowledged-before-me section and applies the notarial seal.
Workers’ Compensation Exemption Affidavit in other Allegheny County cities
Each city publishes its own version of this form. Pick the city where you’re filing.