Form Dr-501 - Homestead Exemption Application Page 4

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DR-501
R. 12/14
Page 2
In addition to homestead exemption, I am applying for the following additional benefits.
See page 3 for qualification and required documents.
14
By local ordinance only:
Age 65 and older with limited income (amount determined by ordinance)
Age 65 and older with limited income and permanent residency for 25 years or more
$500 widowed
$500 blind
$500 totally and permanently disabled
Total and permanent disability - quadriplegic
Certain total and permanent disabilities - limited income and hemiplegic, paraplegic,
wheelchair required, or legally blind
Disabled veteran discount, 65 or older
Veteran disabled 10% or more
Disabled veteran confined to wheelchair, service-connected
Service-connected totally and permanently disabled veteran or surviving spouse
Surviving spouse of veteran who died while on active duty
Surviving spouse of first responder who died in the line of duty
Other, specify:
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 and willfully
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.
15
__________________________________________
________________________________________
Signature, applicant
Signature, Co-applicant
Date
Phone
Date
Phone
Signature, property appraiser or deputy
Date
E Mail Address
Date
Penalties
The property appraiser has a duty to put a tax lien on your property if you received a homestead exemption
during the past 10 years that you were not entitled to. The property appraiser will notify you that taxes with
penalties and interest are due. You will have 30 days to pay before a lien is recorded. If this was not an error by
the property appraiser, you will be subject to a penalty of 50 percent of the unpaid taxes and 15% interest each
year. See section 196.011(9)(a), F.S. For special requirements for estates probated or administered outside
Florida. See section 196.161(1), F.S.
The information in this application will be given to the Department of Revenue. Under s. 196.121, F.S., the
Department and property appraisers can give this information to any state where the applicant has resided.
Social security numbers will remain confidential under s.193.114(5), F.S.
Contact your local property appraiser or
Visit the Department of Revenue web site at

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