Kutztown, PA · Berks County
Contractor Workers’ Compensation Affidavit
This affidavit lets Kutztown contractors state that they do not carry Workers’ Compensation coverage and have no employees, or claim a religious exemption, for the Borough’s Community Development Office.
- 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 Borough of Kutztown Community Development Office form provides options for a sole proprietorship or partnership to attest that it has no Workers’ Compensation coverage and no employees, or for an individual to state a religious exemption. The contractor completes the applicable section and signs the affidavit for notarization. The form includes an acknowledgment section for official use.
Who needs it
A Kutztown contractor completing the no-coverage and no-employees declaration, or an individual claiming the form’s religious exemption, may need this affidavit.
Why it needs a notary
The form carries an acknowledgment block stating that the signer personally appeared and acknowledged signing; the sole proprietor or partner signs before the notary.
How to get this notarized
- 1
Download the Affidavit
Get the Contractor Affidavit from the Borough of Kutztown Community Development Office.
- 2
Complete the Applicable Section
Fill out the section that matches your situation and provide the requested signer and company information.
- 3
Book an Online Notary
Schedule a session with a commissioned online notary.
- 4
Sign on Video
Appear for the notarial acknowledgment and sign as directed during your online session.
- 5
Submit to the Borough
Send the completed affidavit to the Borough of Kutztown Community Development Office.
Preview the form
The blank PDF straight from Kutztown. 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 Kutztown contractor affidavit?
- Choose and complete the applicable section, provide the requested company and signer information, then sign before a commissioned online notary and submit the form to the Borough.
- Do I need to sign the affidavit in front of a notary?
- Yes. The form includes an acknowledgment block for a signer to personally appear before a notary and acknowledge signing.
- Can I use an online notary for this form?
- Pennsylvania authorizes remote online notarization by a commissioned online notary under 57 Pa.C.S. §306.1. Confirm with the city, borough or township if unsure.
- Who can complete the religious exemption section?
- The form’s religious exemption section is written for an individual stating that they do not carry Workers’ Compensation and are claiming a religious exemption.