Application For Local Business Tax Account Exemption Form - Disabled War Veteran
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1
2D I S A B L E D W A R V E T E R A N
APPLICATION FOR LOCAL BUSINESS TAX ACCOUNT EXEMPTION
I, ________________________________________________, hereby certify that I am a bona fide, permanent elector of, Lee
County, state of Florida, who served as an officer or enlisted person in the United States Military Services (regular or reserve)
during periods of active duty during any war, declared or undeclared, armed conflicts, crises etc., who was honorably discharged
or disenrolled from the service of the United States, and who at the time of this application for a local business tax account
hereinafter mentioned shall be disabled from performing manual labor shall, upon sufficient identification, proof of being a
permanent resident elector in this State, and will appear from the certificate of an honorable discharge from the service of the
United States issued to me and attached hereto::
1. I am disabled from performing manual labor, as proof will appear from one or more of the following:
___ a. A certificate of government rated disability to an extent of (10) ten percent or more attached hereto;
___ b. An affidavit or testimony of a reputable physician who personally knows the applicant and who makes oath that the
applicant is disabled from performing manual labor as a means of livelihood;
___ c. A certificate of the veteran’s service officer of the county in which applicant lives, duly executed under the hand and seal
of the chief officer and secretary thereof, attesting the fact that the applicant is disabled and entitled to receive a license
within the meaning and intent of this section;
___ d. A pension certificate issued to applicant by the United States of American by reason of such disability; or
___ e. Such other reasonable proof as may be required by the Tax Collector to establish the fact that such applicant is so
disabled.
2. I claim exemption from the payment of Lee County local business tax receipt under the provisions of Section 205.171
Florida Statutes.
3. The business or occupation for which I desire a license is fully described on the attached application form and such
business or occupation is carried on mainly through my personal efforts as a means of livelihood.
4. In no event will this local business tax receipt permit me to sell intoxicating liquors or malts and vinous beverages.
5. That I have not been allowed exemption on any other local business tax receipt for the current account year and I have not
made application for exemption on any other account for the current year from any Tax Collecting Authority of the State of
Florida or any County thereof, except as follows:
6. My unremarried widow/widower will be entitled to the same exemption in the event of my death.
7. Such local business tax receipt shall not be issued in any other county than my bona fide home of residence, unless I produce
to the Tax Collecting authority in such county a certificate from my home county to the effect that no exemption from a
local business tax receipt has been granted under the authority of Section 205.171 Florida Statutes.
8. Any local business tax receipt obtained under the provisions of this section by the commission of fraud shall be deemed null
and void.
UNDER PENALTIES OF PERJURY, I HEREBY DECLARE THE STATEMENTS AND INFORMATION ABOVE ARE
TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
Signature of applicant: _________________________________________________________ Date: _____________________
VeteransExemption
Form#098
Rev. 12/13/06
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