Stockertown, PA · Northampton County
Workers' Compensation Insurance Affidavit
This affidavit accompanies zoning and building applications and documents whether a homeowner or contractor has workers' compensation coverage or qualifies for an exemption.
- 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
Stockertown requires this form to be submitted, signed, and notarized with every zoning or building application; the requested permit will not be issued until it is completed properly. Homeowners doing the work themselves affirm that they will not employ outside contractors, while contractors provide company and coverage details or state an exemption. Contractors seeking an exemption must sign before a notary, and the form explains that missing coverage or proof may lead to a stop-work order.
Who needs it
Homeowners and contractors submitting a zoning or building application in Stockertown must complete this affidavit and provide applicable coverage or exemption information.
Why it needs a notary
The form includes an acknowledgment block stating the signer appeared and acknowledged execution; a contractor requesting a workers' compensation exemption signs before the notary.
How to get this notarized
- 1
Download the Affidavit
Get the Workers' Compensation Insurance Affidavit from Stockertown.
- 2
Complete Applicable Sections
Identify whether you are the homeowner doing the work or the contractor, and provide the relevant coverage or exemption information.
- 3
Book an Online Notary
If a contractor is requesting an exemption, arrange an online notarization before signing.
- 4
Sign on Video
Appear before the notary by video and acknowledge the document as directed.
- 5
Submit to the Borough
Include the completed affidavit with your zoning or building application.
Preview the form
The blank PDF straight from Stockertown. 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
- Who must complete the workers' compensation affidavit?
- Homeowners or contractors applying for a Stockertown zoning or building permit must submit the form with their application and complete the applicable sections.
- Do I need to notarize this affidavit?
- The form requires notarization when a contractor requests an exemption from workers' compensation insurance. The contractor signs the acknowledgment before a notary.
- How do I submit the completed affidavit?
- Complete the applicable sections and submit the signed, notarized form with your zoning or building application. Contact the borough about submission details or questions.
- Can I sign this form with an online notary?
- Pennsylvania authorizes its commissioned notaries to perform remote online notarizations under 57 Pa.C.S. §306.1; 57 Pa.C.S. §311 gives a notarial act performed in another state the same effect. Confirm with the city, borough or township if unsure.