South Greensburg, PA · Westmoreland County
Worker's Compensation Affidavit
The Worker's Compensation Affidavit is a sworn statement from a South Greensburg permit applicant confirming they will not hire workers for the permitted project unless they provide required coverage.
- 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
This affidavit is for a person applying for a South Greensburg permit who states they will not employ or hire anyone for the project. If the applicant hires workers after receiving the permit, the form says they must notify the Zoning Officer and provide proof of workers’ compensation coverage within three working days. It also warns that noncompliance can lead to a stop-work order that may remain until proper coverage is obtained.
Who needs it
A person applying for a South Greensburg permit for a project who states they will not employ or hire other people for that project needs this affidavit.
How to get this notarized
- 1
Download the Affidavit
Get the Worker’s Compensation Affidavit from South Greensburg’s form page.
- 2
Fill In Your Information
Enter your name and the requested address information, and review the statement before signing.
- 3
Book an Online Notary
Schedule a session with a commissioned online notary and have your identification ready.
- 4
- 5
Submit to the Borough
Submit the notarized affidavit with your permit materials to South Greensburg.
Preview the form
The blank PDF straight from South Greensburg. 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 get this affidavit notarized online?
- Fill in the applicant information, then meet with a commissioned online notary by video. Sign under oath during the session so the notary can complete the jurat.
- Do I need to sign this form in front of a notary?
- Yes. The form includes a “Sworn to and subscribed before me” jurat, which indicates the applicant signs under oath before a notary.
- Can I use an online notary for this affidavit?
- Pennsylvania authorizes remote online notarization under 57 Pa.C.S. §306.1. A commissioned online notary can notarize the applicant’s signature during a live video session.
- What should I do if I hire workers after getting the permit?
- The affidavit says to notify the Zoning Officer and provide proof of workers’ compensation coverage within three working days. For questions about submission, confirm with the city, borough or township if unsure.
Worker's Compensation Affidavit in other Pennsylvania cities
Each city publishes its own version of this form. Pick the city where you’re filing.