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AFFIDAVIT FiELATING TO SECTION 13.12 (c ) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH F?ELATING TO THE LICENSING OF ELECTF3ICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
' ) SS
WINNEBAGO COUNTY ) -
;
� � v� �l�A .�' .4�cE �/� � , � ��
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� 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 ar 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 th2s affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
faaizy.
Dated this oC day of �G�jp/. � 19 -
�•
���
Subscribed and sworn to before
thi s o-�� day of
, �9�.
� � �� � ' �d �
' rdotary Public, Winnebago County, ldisconsin :
My Commission Expires: MY CO�MY�20�1q81PiR�`� �