ORIGINAL APPLICATION FOR AD VALOREM TAX EXEMPTION
BREVARD COUNTY, FLORIDA
**
TAX YEAR:
2018
New:
Change:
Additional:
Property Ide
cation:
Did you receive Homestead or other benefit anywhere last year?
Yes
No
Parcel No:
Tax Acct. No:
Prior
Address:
Legal:
Name:
Mailing
Address:
Ownership Information:
% Ownership:
Tenancy:
Date of Deed:
Book/ Page:
/
Date Recorded:
Use Code:
Type of Deed:
No. of Units:
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, homestead exemption information submitted to property appraisers and intangible tax information submitted to the Department of
Revenue.
Permanent Florida residency required as of January 1
$25,000 Homestead Exemption
Total and Permanent Disability - Quadriplegics
Total and Permanent Disability Exemption
(Documentation Required)
$500 Widow's Exemption
Service Connected Total and Permanent Disability
If you wish to apply for the 65 + additional
$500 Widower's Exemption
Exemption for Disabled Veterans
homestead exemption you must file form
DR-501SC. However, you must either receive or
$500 Disability Exemption
First Responders totally and permanently disabled
apply for the regular homestead to get the 65 +
in the line of duty or surviving spouse
$5000 Veteran Disability Exemption
additional homestead exemption. If you have
already received regular homestead exemption,
Surviving Spouse of First Responder who
$500 Blind Person Exemption
you do not need to file another Form DR-501
died in the line of duty
Proof of residence for all owners:
OWNER 1
OWNER 2
OWNER 3
Address of Owner not Residing
on Property:
Date Permanent Florida
Residency Last Established:
Date Moved Into Home:
Marital Status/Relationship:
Florida Driver's License Number:
Florida Driver's License Issue Date:
Date of Birth:
Florida Vehicle Tag Number:
Brevard County Voter Registration No:
Brevard County Voter Reg. Date:
Immigration Number and Issue Date:
Current Employer:
Employer Address:
Employer Phone No:
Home Phone No.:
Address Listed on Your Last
IRS Return:
Social Security Number:
I hereby authorize this agency to obtain information necessary to determine my eligibility for the exemption(s) applied for.
NOTE: If all information is not received by
March 1st, your application will be processed for whatever exemptions you qualify for on that date.
I hereby make application for the exemptions indicated and affirm that I do qualify for same under Florida Statutes. I am a permanent resident of the State of Florida
and I own and occupy the property described above. I understand that section 196.131(2) Florida Statutes, provides that any person who knowingly and willfully gives
false information for the purpose of claiming homestead exemption is guilty of a misdemeanor of the first degree, punishable by a term of imprisonment not exceeding
1 year or a fine not exceeding $5,000 or both. Further, under penalties of perjury, I declare that I have read the foregoing application and the facts in it are true.
OWNER 1
OWNER 2
OWNER 3
DATE
DEPUTY