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AFFiDAVIT RELATING TO SECTION 13•12 (c ) OF A GENERAL OFiDINANCE
OF THE CITY OF OSHKOSH �?LLATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES '
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
a �
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Nsme '
� Address�
flrst being duly sworn on oath, deposes and says that he is` not
a Yloensed electrician in the Clty 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 assooiated x�th a residence) which is owned a.nd occupied
by him, or is being constructed in his name, as his personal
home and that said residenae or auxi�iary 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 electriaal work authorized by
the permit applied for in connection with thls affidavit, must
be done only by this affiant and that he cannot empZoy others to
asslst with the electrical work but members of hls immediate
family. '
Dated this � day of �-� , 19,`�'�•
,•
Subscribed and sworn to before
thi s a _,of � 19�( �
4�G���-
Notary Pub11c, Winnebago County, Wisoonsin
My Commis;aon Expires:_ /� - .� �- � �j
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