Hendersonville, TN · Sumner County
Affidavit of Exemption
This affidavit lets a Hendersonville building permit applicant state why they are exempt from workers’ compensation insurance proof requirements and select the exemption that applies to their work.
- 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 form is for someone applying for a building permit from the City of Hendersonville’s Building and Codes Department who claims an exemption from workers’ compensation insurance proof requirements under T.C.A. Section 13-7-211. The applicant checks one of three listed reasons: not being required to obtain coverage, working on their own property in their county of residence, or directly supervising that work. The applicant signs and acknowledges the affidavit before a notary.
Who needs it
A Hendersonville building permit applicant claiming one of the form’s listed exemptions from workers’ compensation insurance proof requirements needs to complete this affidavit.
Why it needs a notary
The form has an acknowledgment block; the permit applicant signs the affidavit and acknowledges the signature before the notary public.
How to get this notarized
- 1
Download the Form
Get the Affidavit of Exemption from the City of Hendersonville.
- 2
Fill In the Form
Select one listed exemption reason and complete the date and applicant information.
- 3
Book an Online Notary
Arrange a remote appointment with a commissioned online notary.
- 4
Sign on Video
Appear by video and acknowledge your signature before the notary.
- 5
Submit to the City
Include the notarized affidavit with your building permit application to the City of Hendersonville.
Preview the form
The blank PDF straight from Hendersonville. 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 Affidavit of Exemption?
- Check the one exemption reason that applies, enter the date, and sign the affidavit before a notary. Submit the completed form with your building permit application.
- Do I need to sign the affidavit in front of a notary?
- Yes. The form includes a notary acknowledgment stating that the applicant appeared before the notary and acknowledged signing the instrument.
- Can I use an online notary for this affidavit?
- Tennessee authorizes remote online notarization by a commissioned online notary. Online notaries register through the Secretary of State; you can sign during a video session.
- Which exemption reasons can I select?
- The form lists three choices: you are not required to obtain coverage, you are working on your own property in your county of residence, or you are directly supervising that work.
- Where do I submit the completed affidavit?
- The form is for a building permit application to the City of Hendersonville Building and Codes Department. Confirm submission instructions with the city or town if unsure.
Other forms in Hendersonville
Affidavit of Exemption in other Tennessee cities
Each city publishes its own version of this form. Pick the city where you’re filing.