
Florida Department of Revenue
Original Application for Ad Valorem Tax Exemption
Applicant Name and address
Marital Status
Single Married Widow Widower Divorced
4
Are you or your spouse receiving tax benefits in another county, state or Country?
(i.e. Homestead, school tax relief, tax rebate, rollback, lottery credit, etc.)
Do you or your spouse own property anywhere other than Florida?
Do you or your spouse have an out of state drivers license or vehicle tag?
If yes, Where?
Did you file tax exemptions last year?
If yes, Where?
NOTE: Disclosure of your social security number is mandatory. It is required by section 196.011 (1), Florida Statutes. The social security number will be used to
verify taxpayer identity information and homestead exemption information submitted to property appraisers.
Proof of Residence for all owners
10
Give address of each owner not residing on property
11
Date you last became a permanent resident of Florida
12
Date of occupancy
13
Florida driver license number
14
Florida vehicle tag number
15
Florida voter registration number (if U.S. citizen)
16
Immigration number (Alien Card- if not U.S. citizen)
17
Declaration of domicile
18
Date of birth
19
Current employer
20
Address listed on last IRS return
21
Social Security Number
22
Signature / Date
I authorize this agency to obtain information to determine my eligibility for the exemptions applied for. I qualify for these exemptions under Florida Statutes. I am a permanent resident of the State
of Florida and I own and occupy the property above. I understand that under section 196.131(2), Florida Statutes, any person who knowingly gives false information to claim homestead exemption is
guilty of a misdemeanor of the first degree, punishable by imprisonment up to 1 year, a fine up to $5,000 or both. Under penalties of perjury, I declare that I have read the foregoing application and
the facts in it are true.
NOTE: If all information is not received by March 1st, your application will be processed for whatever exemptions you qualify for on that date.
Permanent Florida residency required as of
January 1
Homestead exemption up to $50,000*
$500 Disability exemption
$500 Blind persons exemption
$5000 Disabled Veteran exemption
Total and permanent disability exemption - Quadriplegics
Service connected total and permanent disability exemption
Exemption for disabled veterans confined to wheelchairs
Total and permanent disability exemption
Surviving spouse of veteran who died while on active duty
Surviving spouse of first responder who died in the line of duty
Age 65 and older with limited income
(amount determined by ordinance)
(Additional documentation may be required)