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AFFIDAVIT FiELATING TO SECTION 13.12 (c ) OF A GENEAAL ORDINANCE
OF THE CITY OF OSFiKOSH �?ELATING TO THE LICENSING OF ELECTAICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
�� , . . ' � �%'�
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 o�,,ned 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
fanily.
Dated this day of _ �i°�F�,�'�t° , 19,�.
Subscribed and sworn to before
thi s ,��(!A 11 day of , 19�.
P7otary Public, Winnebago County, ldisconsin
MY COMMISSION EXPIR�B
My Commission Expires: JULY 20, i9s�