Murfreesboro, TN · Rutherford County
Affidavit of Exemption
This affidavit lets a Murfreesboro building permit applicant state why they are exempt from providing proof of workers’ compensation insurance under the conditions listed on the form.
- 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 City of Murfreesboro Building and Codes Department form is for someone applying for a building permit who claims an exemption from providing proof of workers’ compensation insurance. The applicant selects a listed reason, signs the affidavit, and appears before a notary. The form lists work on the applicant’s own property in their county of residence and not being required to have coverage under Tennessee workers’ compensation law as possible reasons.
Who needs it
A person applying to Murfreesboro’s Building and Codes Department for a building permit who claims one of the form’s workers’ compensation insurance exemptions needs this affidavit.
Why it needs a notary
The applicant signs before the notary, who completes the acknowledgment block confirming the applicant personally appeared and executed the instrument.
How to get this notarized
- 1
Download the Affidavit
Get the Affidavit of Exemption from the City of Murfreesboro.
- 2
Complete the Form
Choose the applicable exemption reason and enter the requested permit and applicant information.
- 3
Book an Online Notary
Schedule a remote session with a commissioned online notary.
- 4
Sign on Video
Sign the affidavit during the video session so the notary can complete the acknowledgment.
- 5
Submit to the City
Submit the notarized affidavit to the City of Murfreesboro Building and Codes Department with your building permit application.
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
- How do I get this affidavit notarized online?
- Complete the affidavit, then book a remote session with a commissioned online notary. Sign during the video session and submit the notarized form to the City of Murfreesboro.
- Do I need to sign the affidavit in front of a notary?
- Yes. The form includes an acknowledgment for the applicant’s signature, with a notary confirming the applicant personally appeared and executed the instrument.
- Can I use a commissioned online notary for this form?
- Tennessee authorizes remote online notarization by a commissioned online notary registered through the Secretary of State. Confirm with the city or town if unsure.
- Who may claim an exemption on this form?
- The form lists applicants working on or directly supervising work on their own property in their county of residence, or applicants not required to have coverage under Tennessee workers’ compensation law.
Other forms in Murfreesboro
Addition and Remodel Application
Murfreesboro
Affidavit of Exemption from Workers’ Compensation Insurance
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
Affidavit of Exemption in other Tennessee cities
Each city publishes its own version of this form. Pick the city where you’re filing.