Form Dr-570 - Application For Homestead Tax Deferral

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DR-570
R.10/11
APPLICATION FOR HOMESTEAD TAX DEFERRAL
Rule 12D-16.002
Section 197.2423, Florida Statutes
Florida Administrative Code
Effective 11/12
Due to the tax collector by March 31
This application is classified confidential if federal income tax returns are attached.
COMPLETED BY TAXPAYER
Applicant
Parcel ID
Mailing
Property
address
address
Phone
Property
description
Date of birth
Number of household members
Current value of primary mortgage outstanding on the home
Other outstanding liens on the homestead
Annual adjusted gross income for all household members based on federal income tax return
Annual adjusted gross income for all household members if no federal income tax return filed
Other income
I am applying to defer payment of a portion or all of the ad valorem taxes and any non-ad valorem
assessments that would be covered by a tax certificate sold under Chapter 197, Florida Statutes, for 20
.
I will submit copies of my federal income tax returns for last year. I will provide other documents as required by the
tax collector, for each member of the household (not including boarders or renters of a portion of this property).
I understand that I must furnish proof of fire and extended coverage insurance at least equal to the total of all
outstanding liens, deferred taxes, non-ad valorem assessments, and interest with a loss payable clause to the
county tax collector.
The information above is true and correct to the best of my knowledge.
____________________________________________
_________________
Signature, applicant
Date
See page 2 for more information.
COMPLETED BY TAX COLLECTOR
Part 1. Ad valorem taxes and non ad valorem
Part 2
assessments. Do not complete if entire amount is deferred
1. Total due before discount
1. Total deferred (taxes and assessments)
2. Interest prior year(s)
2. Less
3% or
5% annual
adjusted gross income
3. All other unsatisfied liens including
primary mortgage outstanding
3. Total deferred
(1 minus 2)
4. Total not deferred
(1 minus 3)
4. Total
(1+2+3)
5. Less applicable discount
5. Just value
6. Total due and payable (4 minus 5)
6. 4 divided by 5 (cannot exceed 85%)
%
7. Total primary mortgage outstanding
8. 7 divided by 5 (cannot exceed 70%)
%
Approved
Not approved
Signature
Date
Date copy sent to applicant

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