Pbctc Form 49 - Application For Business Tax Exemption For Disabled Persons, Widows With Minor Dependents Or Persons 65 Years Of Age Or Older - Palm Beach County Tax Collector
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1
2PALM BEACH COUNTY TAX COLLECTOR
APPLICATION FOR BUSINESS TAX EXEMPTION FOR
DISABLED PERSONS, WIDOWS WITH MINOR DEPENDENTS OR
PERSONS 65 YEARS OF AGE OR OLDER.
(205.162, F.S. & P.B. COUNTY ORDINANCE 72.7)
1.
Applicant resides in Palm Beach County, Florida at __________________
___________________________________________________________
Street and Number
City or Town, Zip
2.
Applicant is claiming exemption from business tax for the privilege of
engaging in the business or occupation in _________________________
at _________________________________________________________
Street and Number
City or Town, Zip
3.
Applicant claims the exemption for the reason marked with an (X):
( ) The applicant is a disabled person physically incapable of manual
labor. If the exemption is claimed for this reason, a physician’s
certificate must accompany this application.
( ) The applicant is a widow with minor dependents, as follows:
Name
Age
Name
Age
__________________ _______
_________________ ________
__________________ _______
_________________ ________
( ) Applicant is ______ years of age.
Place of birth ____________________________
________________
City, State
Date of Birth
If the exemption is claimed for either of the last two reasons, proper
documentation must accompany this application.
4.
No capital other than that of the applicant is used in the conduct of
the said business and the amount of such capital does not exceed
$1,000.00.
5.
Not more than one employee or helper is employed in connection
with said business.
I hereby certify that the above and foregoing answers and statements are
true.
____________________________
Signature of Applicant
PBCTC Form 49 (01/07)
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