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Affidavit of exemption sample

Missouri affidavit exemption 2026

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The document is an 'Affidavit of Exemption for Workers’ Compensation Insurance' from the Missouri Department of Labor and Industrial Relations, which allows contractors in the construction industry to declare their exemption from carrying workers' compensation insurance. It outlines the conditions under which a business can be exempt, such as being a sole proprietor or having no employees, and details the legal implications of providing false information. The affidavit must be submitted when applying for a business license, and failure to comply may result in denial of the license.

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Click ‘Get Form’ to open the Missouri Affidavit of Exemption in the editor.
Begin by entering your name in the designated field for 'Name of Affiant'. Ensure that you are of legal age and sound mind, as this is a sworn statement.
In the next section, provide the name of your business where indicated. This should reflect your official business name engaged in the construction industry.
Select one of the options regarding your employment status: whether you are a sole proprietor, partner, or have filed a Notice of Employer’s Exemption. Make sure to check only one box.
If applicable, attach any required documentation such as acknowledgment letters from the Division and ensure all dates are filled accurately.
Review your affidavit carefully for accuracy before signing. Remember that providing false information can lead to serious legal consequences.
Finally, sign and date the affidavit in front of a notary public to complete the process.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (66 Votes)
2012	4.2 Satisfied (79 Votes)
2003	4.5 Satisfied (44 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Does a sole proprietor need workers comp in Missouri?

Under the Missouri workers compensation law, sole proprietors and partners must individually elect to purchase a valid workers compensation insurance policy for themselves.

Who is exempt from workers comp in Missouri?

Who Needs Workers Comp in MO? Certain types of workers are exempted by state statute including: domestic servants, farm workers, some real estate agents, direct sellers and commercial trucking owner-operators. Employers can choose to cover these groups under workers compensation.

Who is exempt from workers compensation insurance in Missouri?

Certain types of workers are exempted by state statute including: domestic servants, farm workers, some real estate agents, direct sellers and commercial trucking owner-operators. Employers can choose to cover these groups under workers compensation.

How many employees before workers comp is required in Missouri?

Missouri employers with 5 or more employees are required to have workers compensation insurance or qualify as a self-insured. Construction industry employers are required to have workers compensation insurance coverage if they have one or more employees.

What is the Missouri ag exemption form?

In order to claim the Missouri sales tax exemption for agriculture, qualifying agricultural producers must fully complete a Missouri Form 149 Sales and Use Tax Exemption Certificate and furnish this completed form to their sellers.

affidavit of exemption

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Am I exempt from workers comp insurance?

Independent contractors, sole proprietors, business partners, or LLC members in a firm with no employees dont typically need workers compensation. However, clients may request a copy of your workers comp certificate of insurance (COI) before continuing any work with you.

Does a Missouri gift affidavit need to be docHubd?

Gifting Your Vehicle General Affidavit (Form 768) or a written statement indicating the vehicle was given as a gift. NOTE: The General Affidavit or statement does not have to be docHubd. Lien Release (Form 4809), docHubd, if applicable.

What do you need for an affidavit in Missouri?

The affidavit shall: (1) Be taken before an officer with authority to administer oaths; (2) Be made by the person or that persons designee who provided the service; (3) Include an itemized statement of the service and charge.