Macungie, PA · Lehigh County
Workers’ Compensation Information Form
This notarized affidavit records why a property owner or contractor claims an exemption from workers’ compensation insurance when providing information for a building permit.
At a glance
- Issued by
- City of Macungie · Macungie, Lehigh County, Pennsylvania
- Notarization
- Required: sign this form in front of a notary before filing it.
- Official source
- macungie.pa.us
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
- 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 form lets an applicant affirm that workers’ compensation insurance is not required for one of the listed reasons: the property owner is doing the work, the contractor has no employees, or a religious exemption applies. Macungie says to use it when applicable to part C of the workers’ compensation form. For a religious exemption, the form instructs applicants to attach exemption letters for all employees.
Who needs it
A property owner or contractor claiming one of the listed workers’ compensation exemptions for work under a building permit should complete this form.
How to get this notarized
- 1
Download the Form
Get Macungie’s Workers’ Compensation Information Form.
- 2
Fill Out the Affidavit
Enter the requested details and indicate the applicable exemption reason. Attach religious exemption letters if required by the form.
- 3
Book an Online Notary
Schedule a session with a commissioned online notary.
- 4
- 5
Submit to the City
Submit the notarized form with your building permit materials as directed by Macungie.
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 affidavit?
- Choose the exemption reason that applies, provide the requested applicant and property details, and sign before a notary. Attach religious exemption letters for all employees if claiming that exemption.
- Do I need to sign this form in front of a notary?
- Yes. The form says the applicant’s signature must be notarized and includes a subscribed-and-sworn jurat for the notary to complete.
- Can I use an online notary for this form?
- Pennsylvania authorizes remote online notarization by a commissioned online notary under 57 Pa.C.S. §306.1. Check that Macungie will accept the completed form after online notarization.
- Where do I submit the completed form?
- The form is used with the workers’ compensation form for a building permit. Submit it as directed with your permit materials; confirm with the city, borough or township if unsure.