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AFFIDAVIT FiELATING TO SECTION 13•12 (c ) OF i�l GENEHAi, OFiDINANCE
OF TIiE CITY OF OSHKOSH I3ELATING TO THE LICENSING OF ELECTHICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
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-�Name � Address
flrst being duly sworn on oath, deposes and says that he is not
a ]�Soensed electrician in the City of Oshkosh and that he has
applied for an electrical permit to do electrlcal work Sn a
residence and/or auxiliary buildings (intended solely for pur-
poses associated with a residence) which is oHmed and occupied
by him, or is being constructed 1n his name , as hls personal
home and that said residence or auxiliary buildings being so
wired are not to be used or erected for rental purpases or for
resale to present or prospective purchasers.
Affiant understands that the electrical work authorized by
the permit applied for in connectlon with this affidavit , must
be done only by this affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
family.
Dated this � day of l/�:'oi� , 19�,
_____���� = -
Subscribed and sworn to before
this �i � day of /L/ Cti�;.-��'.�„/ 19_�`.
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i%i1�'r, /,�7 /�t 4�!��
Notary Public, Winnebago County, Wisconsin
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