Edinboro, PA · Erie County
Workers’ Compensation Insurance Coverage Affidavit of Exemption
This affidavit lets a property owner or contractor seeking an Edinboro building or zoning permit declare a qualifying exemption from workers’ compensation insurance coverage.
- 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 Edinboro Building and Zoning Department form offers declarations for a property owner doing permitted work, a contractor without employees, or an individual claiming a religious-affiliation exemption. The applicant completes the applicable declaration and signs the affidavit for a permit submission. A contractor claiming no employees must provide a Pennsylvania Contractors Registration number; a religious-affiliation exemption requires a Bureau of Workers’ Compensation Certificate of Exemption for each individual working under the permit.
Who needs it
A property owner or contractor applying for an Edinboro permit and claiming one of the form’s listed workers’ compensation coverage exemptions should complete the applicable declaration.
Why it needs a notary
The form has an acknowledgment-before-me block; the property owner, contractor, or individual making the selected exemption declaration signs before the notary.
How to get this notarized
- 1
Download the Affidavit
Get the Workers’ Compensation Insurance Coverage Affidavit of Exemption from the Borough of Edinboro.
- 2
Complete the Applicable Declaration
Fill in the applicant details and select the declaration that applies to the property owner, contractor, or individual.
- 3
Book an Online Notary
Schedule a video appointment with a commissioned online notary and have valid identification ready.
- 4
Sign on Video
Sign the affidavit during the online notarization session when instructed by the notarial officer.
- 5
Submit to the Borough
Submit the notarized affidavit and any required supporting documents to the Borough of Edinboro Building and Zoning Department.
Preview the form
The blank PDF straight from Edinboro. 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 get this Edinboro affidavit notarized online?
- Complete the applicable exemption declaration, book an appointment with a commissioned online notary, and sign during the video session. Then submit the notarized affidavit and any required supporting documents to the borough.
- Do I need to attach any supporting documents?
- The form says a contractor claiming a religious-affiliation exemption must provide a Certificate of Exemption issued by Pennsylvania’s Bureau of Workers’ Compensation for each individual working under the permit.
- Can this affidavit be notarized remotely?
- Pennsylvania has authorized remote online notarization since 2020. A commissioned online notary can notarize the acknowledgment by video; confirm with the city, borough or township if unsure.
- Who signs the affidavit?
- The property owner, contractor, or individual claiming an exemption signs the declaration that applies to them. The form’s acknowledgment block is completed by the notarial officer.
Other forms in Edinboro
Workers’ Compensation Insurance Coverage Affidavit of Exemption in other Pennsylvania cities
Each city publishes its own version of this form. Pick the city where you’re filing.