Brentwood, TN · Williamson County
Homeowner’s Workers’ Compensation Affidavit
This affidavit lets a homeowner applying for a Brentwood Planning & Codes permit affirm their responsibilities for work on their personal residence and their exemption from workers’ compensation requirements.
At a glance
- Issued by
- City of Brentwood · Brentwood, Williamson County, Tennessee
- Notarization
- Required: sign this form in front of a notary before filing it.
- Official source
- brentwoodtn.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
- 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
Homeowners applying for a permit from the City of Brentwood Planning & Codes Department use this affidavit to describe the project, affirm their responsibilities as their own contractor, and state why they are exempt from workers’ compensation insurance requirements. The form applies only to the permit described in the affidavit; the homeowner agrees to complete another notarized affidavit for another permit. It also includes limits and conditions for homeowner permits and work performed by others.
Who needs it
A homeowner applying for a Brentwood Planning & Codes permit for work on their personal residence who will act as their own contractor needs this affidavit.
Why it needs a notary
The form includes a notarial acknowledgment stating the homeowner personally appeared, affirmed the information, and executed the instrument; the homeowner signs before the notary.
How to get this notarized
- 1
Download The Affidavit
Get the Homeowner’s Workers’ Compensation Affidavit from the City of Brentwood.
- 2
Complete The Form
Enter your homeowner and project details, then select the applicable exemption statement.
- 3
Book An Online Notary
Arrange a remote session with a commissioned online notary.
- 4
Sign On Video
Appear before the notary by video and sign as directed.
- 5
Submit To The City
Submit the completed affidavit with your permit application to Brentwood Planning & Codes.
Preview the form
The blank PDF straight from Brentwood. 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 this homeowner affidavit?
- Fill in your contact and project details, select the applicable workers’ compensation exemption statement, and sign before a notary. The form says it applies only to the permit described.
- Do I need to sign this affidavit in front of a notary?
- Yes. The form includes a notarial acknowledgment stating that the homeowner personally appeared before a notary, affirmed the information, and executed the instrument.
- Can I use one affidavit for multiple permits?
- The form says the affidavit applies only to the permit described. If you need another permit, it instructs you to complete and notarize another affidavit.
- Can I sign with a commissioned online notary?
- Tennessee authorizes remote online notarization by a commissioned online notary registered with the Secretary of State. Confirm with the city or town if unsure whether it will accept the remotely notarized affidavit.