Macungie, PA · Lehigh County
Workers’ Compensation Exemption Affidavit
This notarized affidavit lets a property owner or contractor explain why workers’ compensation insurance is not required and is filed with the municipality 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
Use this form with the workers’ compensation information for a building permit when the property owner is doing the work, the contractor has no employees, or a religious exemption applies. The applicant affirms the selected reason and signs the affidavit before a notary. The form notes that contractors must provide proof of insurance when required and that religious exemption letters for all employees should be attached.
Who needs it
A building permit applicant who claims one of the listed workers’ compensation exemptions uses this affidavit with the municipality.
How to get this notarized
- 1
Download the Affidavit
Get the Workers’ Compensation Exemption Affidavit from the Macungie form source.
- 2
Complete the Form
Enter the property and applicant information, then indicate the applicable exemption.
- 3
Book an Online Notary
Schedule a session with a commissioned online notary before signing.
- 4
Sign on Video
Sign the affidavit during the online notarization session so the notary can complete the jurat.
- 5
Submit to the Municipality
Submit the notarized affidavit with the workers’ compensation information for your building permit.
Preview the form
The blank PDF straight from Macungie. 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 the workers’ compensation exemption affidavit?
- Select the applicable exemption, complete the applicant information, and sign before a notary. Attach religious exemption letters for all employees if claiming the religious exemption.
- Do I need to notarize this affidavit?
- Yes. The form says it requires a notary seal and that the applicant’s signature must be notarized.
- Can I sign this affidavit with an online notary?
- Pennsylvania has authorized remote online notarization for its own notaries under 57 Pa.C.S. §306.1 since 2020. Confirm with the city, borough or township if unsure whether it accepts an electronically notarized version of this form.
- What should I attach if I claim a religious exemption?
- The form instructs applicants to attach copies of religious exemption letters for all employees.
Other forms in Macungie
Workers’ Compensation Exemption Affidavit in other Pennsylvania cities
Each city publishes its own version of this form. Pick the city where you’re filing.