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AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY ) •
/e2_
4-r-2fC 3
(Name) '?f.-4-. Address)
first being duly sworn on oath, deposes and says that he is not
a licensed 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 authorized by
the permit applied 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 immediate
family.
Dated this / ( day of 1
Subscri • -d and sworn to before
this . , / day of ,n . .4111 , 19,
Notary Public, Winnebago County, Wisconsin
My Commission Expires: 6-72--P__,