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AFFIDAVIT F�ELATING TO SECTION 13.12 (c ) OF A GENEAAL ORDINANCE �
OF THE CITY OF OSHKOSH AELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES f
STATE OF WISCONSIN) ��
) SS =
WINNEBAGO COUNTY )
' l+ l l�Y!C� � �Q �. � �t1 D f��
Name
Addre s s
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 bulldings (intended solely for pur-
poses associated with a residence) which is ov�med 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 connection with this affidavit, must
be done only by th2s affiant and tha,t he cannot employ others to
assist with the electrical work but members of his immediate
family.
Dated thi s day of /�4i��� '' �
, 19 7.s. ;
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Subscribed and sworn to before
F
thi s --^�� day of ,U
, 19�s:
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Notary Public, Winnebago County, Wisconsin
My Commission Expires: ' '� ' � " �
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