Looking for a Florida Department Of Revenue Forms And Templates? Download it for free!

Form Dr-501cc - Ad Valorem Tax Exemption Application Proprietary Continuing Care Facility

DR-501CC

AD VALOREM TAX EXEMPTION APPLICATION

R. 11/12

Rule 12D-16.002

PROPRIETARY CONTINUING CARE FACILITY

Florida Administrative Code

Effective 11/12

Section 196.1977, Florida Statutes

File this form with the county property appraiser in the county where the facility is by March 1 of each year.

Organization name

Mailing

Address of

address

property, if

different

Phone

County of facility

Property owner

Parcel ID or legal description

Was the organization certified under Chapter 651, F.S., as of January 1 of the year applied for?

yes

If yes, provide a copy of the certification.

Is the organization qualified for an exemption under section 196.1975, F.S., or other exemptions?

yes

Number of units and apartments that qualify for $25,000 exemption under s. 196.1977(1)(2),F.S.

Number of units and apartments in the facility

I have included an affidavit for each eligible resident of a qualified unit.

I understand as owner, I must disclose to a qualified resident the amount of the benefit and how he or she will

receive it. I affirm the resident will receive the full benefit from this exemption in either an annual or monthly

credit to his or her unit’s monthly maintenance fee. If a resident later qualifies for the exemption, I will disclose

the same information.

I certify all information on this form and any attachments is true and correct as of January 1 of this year to the

best of my knowledge.

Signature

Print name

Date

Title

INSTRUCTIONS

To apply for this exemption, a proprietary

For each qualifying unit, on January 1 the resident must:

continuing care facility must:

hold a continuing care contract under Chapter 651, F.S.

be certified under Chapter 651, F.S.

reside in and make the unit his or her permanent home

not qualify for an exemption under section

not be eligible for any other homestead exemption

file an affidavit with the facility.

196.1975, F.S., or similar exemption, on

January 1 of the year applied for.

Include an affidavit (sample on page 2) for each qualifying

residents with this application.

Form Dr-501cc - Ad Valorem Tax Exemption Application Proprietary Continuing Care Facility

Related Articles

Related forms

Related Categories