St. Lawrence, PA · Berks County
Workers’ Compensation Exemption Affidavit
This affidavit lets a Saint Lawrence permit applicant swear that workers’ compensation insurance is not required for a listed reason and affirm compliance with the form’s project conditions.
- 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 Saint Lawrence form asks the applicant to identify a reason they are exempt from providing workers’ compensation insurance, such as having no employees or qualifying executive employees. The applicant also swears or affirms they understand and will follow the listed requirements for subcontractor coverage and project workers. Complete and notarize the affidavit when applying for a permit that requires this exemption statement.
Who needs it
A Saint Lawrence permit applicant claiming they are not required to provide workers’ compensation insurance for one of the reasons listed on the affidavit needs this form.
How to get this notarized
- 1
Download the Affidavit
Get the Borough of Saint Lawrence Workers’ Compensation Exemption Affidavit.
- 2
Complete the Form
Enter the applicant information, indicate the applicable exemption reason, and review the conditions.
- 3
Book an Online Notary
Schedule a session with a commissioned online notary before signing.
- 4
Sign on Video
Sign and swear or affirm the affidavit during the online notarization session.
- 5
Submit to the Borough
Return the notarized affidavit with the Saint Lawrence permit application.
Preview the form
The blank PDF straight from St. Lawrence. 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 notarize the workers’ compensation exemption affidavit?
- Complete the affidavit, then meet with a commissioned online notary by video. Sign and swear or affirm the statement during the session, then submit the notarized form with your permit application.
- Do I need to sign this affidavit in front of a notary?
- Yes. The form says it is not valid without a notary and includes a subscribed-and-sworn jurat. Sign and swear or affirm before the notary.
- Can I use an online notary for this Borough form?
- Pennsylvania authorizes remote online notarization by a commissioned online notary. Confirm with the city, borough or township if unsure whether Saint Lawrence will accept the remotely notarized affidavit.
- Who may sign the affidavit?
- The form provides a signature line for the applicant or an authorized agent. The signer swears or affirms that the applicant qualifies for an exemption and will comply with the listed conditions.
Other forms in St. Lawrence
Workers’ Compensation Exemption Affidavit in other Pennsylvania cities
Each city publishes its own version of this form. Pick the city where you’re filing.