Manheim, PA · Lancaster County
Workers’ Compensation Exemption Form
This form lets a contractor claiming a workers’ compensation exemption provide the basis for that claim to Manheim Borough’s Codes Department for a building permit.
- 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
Manheim Borough asks contractors claiming a workers’ compensation exemption to complete this form and sign it before a notary. The contractor selects and explains the basis for the exemption, then submits the form to the Codes Department. The Borough keeps a submitted exemption form only through December 31 of that year, so the contractor is responsible for renewing it annually. Contractors providing an insurance certificate must ask their insurer to name the Borough as certificate holder.
Who needs it
A contractor applying for a Manheim Borough building permit who claims a workers’ compensation exemption must complete and submit this form.
Why it needs a notary
The form has a “Sworn to and subscribed before me” jurat; the contractor or applicant signs before the notary.
How to get this notarized
- 1
Download The Form
Get the Workers’ Compensation Exemption Form from Manheim Borough’s document page.
- 2
Complete The Form
Choose the basis for the exemption and provide any explanation requested on the form.
- 3
Book An Online Notary
Arrange a session with a commissioned online notary and have identification ready.
- 4
Sign On Video
Sign the form during the online session when directed by the notary.
- 5
Submit To The Borough
Send the notarized form to Manheim Borough’s Codes Department and follow up about filing details if needed.
Preview the form
The blank PDF straight from Manheim. 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 and submit this exemption form?
- Select and explain the basis for the exemption, sign in front of a notary, and submit the completed form to Manheim Borough’s Codes Department. The form says the contractor must renew it annually.
- Do I need to renew the exemption form each year?
- Yes. The form says Manheim Borough keeps an exemption form only through December 31 of the year it was submitted, and the contractor is responsible for renewing it annually.
- Can I sign this form with an online notary?
- Pennsylvania has authorized remote online notarization for its own notaries since 2020 under 57 Pa.C.S. §306.1. Confirm with the city, borough or township if unsure whether Manheim accepts remote notarization for this form.
- What if I provide workers’ compensation insurance instead?
- The form says to notify your insurance company that Manheim Borough must be named as the policy certificate holder. Contact the Borough Codes Department for any additional submission instructions.