Hanover, PA · York County
Workers’ Compensation Affidavit
This affidavit is for people seeking a Hanover building permit who state they will not hire anyone for the project and agree to notify the Borough if that changes.
- 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 the permit applicant’s statement that they will not employ or hire other people for the project. If they later hire anyone, they agree to notify the Borough Office and provide proof of workers’ compensation coverage within three working days. The form warns that failure to comply may result in a stop-work order. It includes spaces for the permit address, applicant contact details, signature, and notarial certification.
Who needs it
A person seeking a Hanover building permit who states they will not hire others for the project should complete this affidavit.
How to get this notarized
- 1
Download the Affidavit
Get the Workers’ Compensation Affidavit from the Borough of Hanover.
- 2
Fill In the Form
Enter the permit address and your name, address, and telephone number.
- 3
Book an Online Notary
Schedule a remote session with a commissioned online notary.
- 4
Sign on Video
Sign and swear to the affidavit during the online notarization session.
- 5
Submit to the Borough
Send the completed affidavit to the Borough with your building permit materials.
Preview the form
The blank PDF straight from Hanover. 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?
- Fill in the requested permit and contact information, then sign and swear to the affidavit before a commissioned online notary. Submit the completed form to the Borough with your building permit materials.
- Do I need to sign this affidavit in front of a notary?
- Yes. The form includes a jurat stating that it was subscribed and sworn to before a notary, with spaces for the notary’s signature and commission expiration.
- Can I use an online notary for this form?
- Pennsylvania authorizes remote online notarization by a commissioned online notary. Confirm with the city, borough or township if unsure whether Hanover accepts this notarization for the permit filing.
- What if I hire someone after receiving the permit?
- The affidavit says you must notify the Borough Office and provide proof of workers’ compensation coverage within three working days if you hire anyone after receiving the building permit.
Other forms in Hanover
Workers’ Compensation Affidavit in other Pennsylvania cities
Each city publishes its own version of this form. Pick the city where you’re filing.