Mount Joy, PA · Lancaster County
Workers Compensation Affidavit of Exemption
This affidavit lets a property owner or contractor state why workers’ compensation coverage is not required for construction work connected to a Mount Joy zoning or construction 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
The affidavit records whether the property owner will perform the work, the contractor has no employees, or the contractor qualifies for a religious exemption. The applicant, contractor, or property owner completes it when seeking a Mount Joy zoning or construction permit and is not required to provide workers’ compensation insurance. The form warns that hiring workers may require proof of coverage and that noncompliance may result in a stop work order.
Who needs it
A property owner or contractor seeking a Mount Joy zoning or construction permit who claims an exemption from workers’ compensation coverage should complete this affidavit.
Why it needs a notary
The form includes a jurat and acknowledgment: the named affiant signs and swears to the statements before the notary, who completes the certificate.
How to get this notarized
- 1
Download the Affidavit
Get the Workers Compensation Affidavit of Exemption from the Borough of Mount Joy.
- 2
Complete the Form
Identify the applicable exemption and fill in the applicant, company, contact, and date information.
- 3
Book an Online Notary
Schedule a session with a commissioned online notary before signing the affidavit.
- 4
Sign on Video
Appear for the video session, sign the affidavit, and swear to its statements before the notary.
- 5
Submit to the Borough
Send the notarized affidavit with your Mount Joy zoning or construction permit materials.
Preview the form
The blank PDF straight from Mount Joy. 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 notarize this affidavit?
- Fill in the applicable exemption information, then book with a commissioned online notary. Sign and swear to the statements during the video session, and submit the completed affidavit with your permit materials.
- Do I need to provide workers’ compensation proof if I hire a contractor?
- The form says a contractor hired to perform construction work must provide proof of workers’ compensation insurance to the Mount Joy Borough Building Code Official. It also states the property owner assumes liability for contractor compliance.
- Can I sign the affidavit online with a notary?
- Pennsylvania authorizes its commissioned notaries to perform remote online notarizations. An act performed in another state has the same effect as one performed by a notary commissioned in Pennsylvania.
- What happens if I hire workers after filing the affidavit?
- The form says you must notify the Mount Joy Borough Building Code Official before hiring or employing anyone and provide proof of workers’ compensation coverage for that individual.
- Where should I submit the completed affidavit?
- The affidavit is associated with an application for a Mount Joy zoning or construction permit. Confirm the submission method and any additional requirements with the borough if unsure.
Workers Compensation Affidavit of Exemption in other Pennsylvania cities
Each city publishes its own version of this form. Pick the city where you’re filing.