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AFFIDAVIT I3ELATING TO SECTION 13.12 {c ) OF A GENERAL 08DINANCE �
OF THE CITY OF OSHI�OSH AELATING TO THE LICENSING OF ELECTI3ICIANS �
AND PAOVIDING PENALTIES �
�
3TATE OF WISCONSIN)
) SS �
WINNEBAGO COUNTY ) �
C
�'t��-�t � �!�'O'e , �� / ��a��
Name Address
first being duly sworn on oath, deposes and says that he is not
a �iaensed electrician in the City of Oshkosh and that he has
appl�ied for an electrical permit to do electrical work in a
residenoe and/or auziliary buildings (intended solely for pur- �
poses associated �aith 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 erecte� 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 this affiant and that he cannot� employ others to �
assist with the electrical work but members of his immediate � �
faoily.
Dated this � da.y of �,0/�� / , 19�3.
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Subscribed and sworn to bef'ore �
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this ; day of , 19�. �
�� h o4,.u I � I�IJIT,U� �
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Notary Public, Winnebago County, Wisconsin �
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My Commission Expires: � (� �jo �
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