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AFFIDAVIT RELATING TO SECTION 13•12 (c ) OF A GENEAAL 08DINANCE
OF THE CITY OF OSHKOSH �?ELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES '
STATE OF WISCONSIN)
) SS
WINNffiAGO COUNTY )
✓
� � �_ � � ;
�. , � i
Na Add '
first being duly sworn on oath, deposes and says that he is not
a aloensed electrician in the City of Oshkosh and that he has
applied for an electrical parmit to do electrical work in a
re$idence and/or auxiliary buildings (interided solely for pur-
poses assooiated Kith a residence) which is owned and occupied
by him, or is being constructed in his naoe, as his personal
home and that sald 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 aff�davit , must
be done only by this affian� and that he Gar�not empZoy others to
assist with the electricai work but members of his immediate
famizy.
Da te d thi s ,_�_� �ay of �,,��� � 19,,,�� �
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Subscribed and sworn t before
thi s day of , 19,,�,.
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Nc�ary Public, Winnebago County, Wisconsin
My Commission Expires:_ /� ��. 3 � 7J