Murfreesboro, TN · Rutherford County
Affidavit of Exemption from Workers’ Compensation Insurance
This affidavit is for a Murfreesboro building permit applicant who claims an exemption from providing proof of workers’ compensation insurance under one of the listed conditions.
- 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 lets a building permit applicant state why they are exempt from the requirement to provide proof of workers’ compensation insurance. Murfreesboro’s Building and Codes Department form lists three possible grounds: work on the applicant’s own property in their county of residence, directly supervising that work, or not being required to have coverage under the Tennessee Workers’ Compensation Law. The applicant signs and submits it with the building permit application.
Who needs it
A person applying for a Murfreesboro building permit who claims one of the form’s listed exemptions from providing proof of workers’ compensation insurance needs this affidavit.
Why it needs a notary
The form has a notarial acknowledgment block; the permit applicant signs the affidavit before the notary, who completes the appearance, signature, date, and commission-expiration details.
How to get this notarized
- 1
Download the Affidavit
Get the City of Murfreesboro Affidavit of Exemption from Workers’ Compensation Insurance.
- 2
Complete the Form
Enter the requested details and select the exemption ground that applies to your situation.
- 3
Book an Online Notary
Arrange a remote session with a commissioned online notary.
- 4
Sign on Video
Sign the affidavit during the video session and have the notary complete the acknowledgment block.
- 5
Submit to the City
Submit the notarized affidavit with your building permit application to the Building and Codes Department.
Preview the form
The blank PDF straight from Murfreesboro. 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
- What is the workers’ compensation exemption affidavit for?
- It allows a Murfreesboro building permit applicant to state that they meet one of the form’s listed grounds for exemption from providing proof of workers’ compensation insurance.
- Who signs the affidavit?
- The building permit applicant fills out and signs the affidavit. The form includes a notarial acknowledgment block for the applicant’s signature.
- How do I submit the completed affidavit?
- Complete the affidavit, sign it before a notary, and submit it with your building permit application to the City of Murfreesboro Building and Codes Department. Confirm with the city or town if unsure.
- Do I need to sign in front of a notary?
- Yes. The form includes a notarial acknowledgment block, so sign the affidavit before the notary and have the notary complete the block.
- Can I use an online notary for this form?
- Tennessee authorizes remote online notarization by a commissioned online notary. You can sign during a video session; check with the City of Murfreesboro about its submission requirements.
Other forms in Murfreesboro
Addition and Remodel Application
Murfreesboro
Commercial Builder Affidavit of Compliance
Murfreesboro
Commercial Building Permit for Tents, Construction Trailers, and Temporary Structures
Murfreesboro
Homeowner Building Permit Affidavit
Murfreesboro
Request for Residential Pool, Hot Tub and Spa Permit
Murfreesboro
Sidewalk Cafe Application and License
Murfreesboro