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AFFIDAVIT BEI�ATING TO SECTION 13.12 (c ) OF A GENEAAL ORDINANCE
OF THE CITY OF OS�COSH AELATING TO T� LICENSING OF ELECTAICIANS
AND PH04IDING PENALTIES
STATE OF WISCONSIN)
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'� WINNEBAGO COUNTY )
_ _J y�, N; �>c_ �'1 G� C, 1� � �{C� 1 i�u . � �� � h �,�' Q -
Name Address
first being duly sworn on oath, deposes and says that he is not F
a 2laeased electrician in the City oP Oshkosh and that he has =
appl�ied for an electrical permit to do electrical �ork in a ,
residenae and/or au=iliary buildings (intended solely for pur-
poses associated xith a residence) which is owned and occupied i
by him, or is being constructed ia his name, as his personal
home and that said residence or au=iliary buildings being so
v+ired are not to be used or ereated for rental purposes or Por
� resale to present or prospective purchasers.
APfiant understands that the electrical work authorized by
the permit applied for 3n connection wtth this aPfidavit, must ;
be done onlq by this atfiant and that he cannot employ others to
assist �ri.th the electrical �rork but members of his immediate
family. °
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Dated this ���� day oP �� ��- , 19�� •
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Subscribed and swo to before s
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this ��G� �lay oP ��� - �t� , 19,ZL• G
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, Notary � ublia, Winnebag County, Wisconain �
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My Commission E�cpires: ` �_ 7 /� ��
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