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AFFIDAVIT AELATING TO SECTION 13.12 (c ) OF A GENEHAL OADINANCE
�F THE CITY Or^ OSHISOSA fiELATING TO THE LICENSING OF ELECTAICIANS
AND PAOVIDING PENALTIES
STATE OF LdISCONSIN)
) SS
WINNEBAGO COUNTY )
_ �--S�a 7"� /l/�"� , �i-i`S— h! � 9� �'-�-e
Name Address
first being duly sworn on oath, deposes and says that he is not
a ]�icensed electrician in the City of Oshkosh and that he has
applied for an electrical permit to do electrical work in a
residence and/or auxiliary buildings (intended solely for pur-
poses associated with a residence ) which is owned and occupied
by him, or is being constructed in his name , as his personal
home and that said residence or auxiliary buildings being so
wired are not to be used or erected for rental purposes or for
resale to present or prospective purchasers.
Affiant understands that the electrical work avthorized by
the permit applied for in connection wlth this affidavit , must
be done only by thls affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
fanily.
Dated this ��_ day of F�",�,..c_ , 19�
� � �
Subscribed and sworn to before
this _� day of �iL, 19��. -.
- .� � ,� ���,���.� - ; _
P7otary Publlc, Gdinnebago County, ldisconsin � � � = :
�:�v comr�issio,v ex�i;_; �
. ;.
My Commission �xpires7 JULY20, i�;l . "