Pennsylvania · Form type
Workers’ Compensation Exemption Affidavit
This notarized affidavit identifies why workers’ compensation insurance is not required and is completed by an applicant submitting the information with a building permit.
Available in 11 cities.
Cities offering this form
Avondale
Workers’ Compensation Exemption Affidavit
Bethel Park
Workers’ Compensation Exemption Affidavit
Clairton
Workers’ Compensation Exemption Affidavit
Edinboro
Workers’ Compensation Exemption Affidavit
Franklin Park
Workers’ Compensation Exemption Affidavit
Macungie
Workers’ Compensation Exemption Affidavit
Mount Joy
Workers’ Compensation Exemption Affidavit
Patterson Heights
Workers’ Compensation Exemption Affidavit
Pittsburgh
Workers’ Compensation Exemption Affidavit
St. Lawrence
Workers’ Compensation Exemption Affidavit
Whitehall
Workers’ Compensation Exemption Affidavit