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FI
AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OS$KOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
SS
WINNEBAGO COUNTY )
Name ~'~ Address .-~"~
first being duly sworn on oath, deposes and says that. he 1s not
a 3loens~d electrician in the City of Oshkosh and that he has
applied Por an electrical permit to do electrical work in a
residence and/or .auxiliary buildings (intended solely for pur-
poses associated Kith 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.
Affis-nt understands that the electrical work authorized by
the permit applie8 for in connection 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 inpmediate
family.
Dated this ~__.~~ day of
/!( 1~
Subscribed and sworn to before
thi day of ,_„_, 19~~
PTotary Public, W nnebago County, Wisconsin
19.,x•
My Commission Expires:~ -aZ ~~'-
7 _.__