Original Application For Ad Valorem Tax Exemption Form - Florida Department Of Revenue
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2Florida Department of Revenue
EX501FL
Original Application for Ad Valorem Tax Exemption
County ____________________ Tax Year __________
Case ____________________
Clerk ______________________
_________________________________________
New ______
Change ______ Additional ______
Property ID:
Applicant Name and Address:
____________________________________________________________________
Permanent Florida residency required
____________________________________________________________________
as of January 1
____________________________________________________________________
Homestead exemption up to $50,000*
____________________________________________________________________
$500 Widow’s exemption
)
____________________________________
Co-Applicant name(s
:
1
$500 Widower’s exemption
Legal Description:
$500 Disability exemption
____________________________________________________________________
$500 Blind persons exemption
____________________________________________________________________
$5000 Disabled Veteran exemption
2
__________________________
Phone: _______________________________
Total and permanent disability exemption – Quadriplegics
(Documentation required)
3
Marital status:
Single
Married
Widow
Divorced
Widower
Service connected total and permanent disability exemption
Are you or your spouse receiving tax benefits in another county, state,
(Documentation required)
4
Exemption for disabled veterans confined to wheelchairs
or Country? (i.e. Homestead, school tax relief, tax rebate, rollback,
(Documentation required)
lottery credit, etc.)
Total and permanent disability exemption
_____ Yes ____No
If yes, Where? ______________________________________
(Documentation required)
*
To apply for an additional homestead exemption enacted by local ordinance for persons
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Your last year’s address:
_____ Own
____Rent
____Other
age 65 and older you must file form DR-501SC. You must either receive, or apply for, the
____________________________________________________________________
regular homestead to get this additional homestead exemption. If you have already
____________________________________________________________________
received regular homestead exemption, you do not need to file another form DR-501.
6
Do you or your spouse own property anywhere other than Florida?
_____ Yes ____No If yes, Where? ______________________________
7
Do you or your spouse have an out of state drivers license or vehicle tag?
Ownership information
_____ Yes ____No If yes, Where? ______________________________
Did you file tax exemptions last year? _______ Yes
_______ No
8
Percent of ownership __________
Type of Deed _______________
Where: ________________________________________________________
Recorded: Book _______________
Page ______________________
Date recorded _________________
Date of Deed _______________
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Email Address: __________________________________________________
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
Give address of each owner not residing on property
10
Date you last became a permanent resident of
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Florida
Date of occupancy
12
Florida driver license number
13
(Date)
(Date)
(Date)
Florida vehicle tag number
14
Florida voter registration number
15
(Date)
(Date)
(Date)
(If U.S. citizen)
Immigration number
16
(Alien Card – if not a U.S. citizen)
(Date)
(Date)
(Date)
Declaration of domicile
17
Res. date
Res. date
Res. date
Date of birth
18
Current employer
19
20
Address listed on your last IRS return
Social Security Number
21
Signature/Date
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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.
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