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

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DR-501CC
R. 11/12
AD VALOREM TAX EXEMPTION APPLICATION
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
no
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
no
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
196.1975, F.S., or similar exemption, on
file an affidavit with the facility.
January 1 of the year applied for.
Include an affidavit (sample on page 2) for each qualifying
residents with this application.

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