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AFFIDAVIT kELATING TO SECTION 13.12 (c ) OF r� GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PAOVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
�� � ,�- � � /�r� � � �
Name —�TAddre s s
first being duly sworn on oath, deposes and says that he is not
a ]�loensed electrician in the City of Oshkosh and that he has
applied for an electrical permit to do electrical work in a
residenae and/or auxiliary buildings (intended solely for pur-
poses associated with a residence ) which is oc��ned 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 thls affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
faoily. �
Dated thi s day of ��/.�' , 19 7�
' ,r \
Subscribed and sworn to before
thi s q � day of , 19��.
� �
Notary Public, Winnebago County, laisconsin
MY COMMISSION EXPIRES
My Commission Expires: �utY 20� 19si