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AFFIDAVIT kELATING TO SECTION 13•12 (c ) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSIi RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVZDING PENALTTES '
STATE OF WZSCONSIN)
) SS
WINNEBAGO COUNTY )
�/ D f� SL�h�i /S C � , �02.�.2 L✓, �,2. �s� V`=
Ng� Addre s s '�
first being duly sworn on oath, deposes and says that he is not
a lioensed e2ectrician in the City of Oshkosh and that he has
applied Por an electrical permit to do electrical work in a
residence and/or au$iliary buildings �intended solely for pur-
poses assoolated xith 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 connectian with this affidavit, must
be done only by this affiant and that he cannot employ others to
assist with the electricai work but members of h1s immediate
family.
Dated this �..Z ctay of U L , 19�.
,
.
Subscribed and sworn to bei' e
thi s ���da o , 19 ��,
� _�...� �
�\
i�otary Public, Winnebago County, Wisconsin
My Commission Expires: �� -�, �� ��