Form DR-501CC "Ad Valorem Tax Exemption Application and Return for Proprietary Continuing Care Facility" - Florida

What Is Form DR-501CC?

This is a legal form that was released by the Florida Department of Revenue - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2021;
  • The latest edition provided by the Florida Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DR-501CC by clicking the link below or browse more documents and templates provided by the Florida Department of Revenue.

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Download Form DR-501CC "Ad Valorem Tax Exemption Application and Return for Proprietary Continuing Care Facility" - Florida

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DR-501CC
R. 11/21
AD VALOREM TAX EXEMPTION APPLICATION
Rule 12D-16.002
F.A.C.
AND RETURN FOR PROPRIETARY
Effective 11/21
CONTINUING CARE FACILITY
Page 1 of
2
Section 196.1977, Florida Statutes
This application is for use by certified continuing care facilities that are not qualified for exemption as a
nonprofit home for the aged to apply for an ad valorem tax exemption, as provided in section (s.) 196.1977,
Florida Statutes (F.S.).
This completed application, including all required attachments, must be filed with the county property appraiser
on or before March 1 of the current tax year.
Applicant name
Facility name
Mailing
Physical address,
address
if different
Business
County where property
Select County
phone
is located
Parcel identification or legal description
1. On January 1 of the current year, did the applicant hold a valid Certificate of Authority as a Continuing Care
Provider, certified by the Florida Office of Insurance Regulation under Chapter 651, F.S.?
Yes
No
If yes, attach a copy of the certification.
2. Is the applicant qualified for an exemption under s. 196.1975, F.S., as a nonprofit home for the aged or other
ad valorem tax exemption?
Yes
No
3. On January 1 of the current year, the number of units and apartments that qualify for $25,000
exemption under s. 196.1977(1) and (2), F.S.
4. On January 1 of the current year, the number of units and apartments in the facility
I have included an affidavit for each eligible resident of a qualified unit or apartment.
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 application, including any attachments, is true, correct, and in effect on January
1 of the tax year.
Signature
Print name
Date
Title
INSTRUCTIONS
To apply for this exemption, a
For each qualifying unit or apartment, on January 1 the
proprietary continuing care facility must:
resident must:
 be certified under Chapter 651, F.S.
 hold a continuing care contract under Chapter 651, F.S.
 not qualify for an exemption under
 reside in and make the unit his or her permanent home
 not be eligible for any other homestead exemption
section 196.1975, F.S., or similar
 file an affidavit with the facility.
exemption, on January 1 of the year
applied for.
Include an affidavit (sample on page 2) for each qualifying
residents with this application.
DR-501CC
R. 11/21
AD VALOREM TAX EXEMPTION APPLICATION
Rule 12D-16.002
F.A.C.
AND RETURN FOR PROPRIETARY
Effective 11/21
CONTINUING CARE FACILITY
Page 1 of
2
Section 196.1977, Florida Statutes
This application is for use by certified continuing care facilities that are not qualified for exemption as a
nonprofit home for the aged to apply for an ad valorem tax exemption, as provided in section (s.) 196.1977,
Florida Statutes (F.S.).
This completed application, including all required attachments, must be filed with the county property appraiser
on or before March 1 of the current tax year.
Applicant name
Facility name
Mailing
Physical address,
address
if different
Business
County where property
Select County
phone
is located
Parcel identification or legal description
1. On January 1 of the current year, did the applicant hold a valid Certificate of Authority as a Continuing Care
Provider, certified by the Florida Office of Insurance Regulation under Chapter 651, F.S.?
Yes
No
If yes, attach a copy of the certification.
2. Is the applicant qualified for an exemption under s. 196.1975, F.S., as a nonprofit home for the aged or other
ad valorem tax exemption?
Yes
No
3. On January 1 of the current year, the number of units and apartments that qualify for $25,000
exemption under s. 196.1977(1) and (2), F.S.
4. On January 1 of the current year, the number of units and apartments in the facility
I have included an affidavit for each eligible resident of a qualified unit or apartment.
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 application, including any attachments, is true, correct, and in effect on January
1 of the tax year.
Signature
Print name
Date
Title
INSTRUCTIONS
To apply for this exemption, a
For each qualifying unit or apartment, on January 1 the
proprietary continuing care facility must:
resident must:
 be certified under Chapter 651, F.S.
 hold a continuing care contract under Chapter 651, F.S.
 not qualify for an exemption under
 reside in and make the unit his or her permanent home
 not be eligible for any other homestead exemption
section 196.1975, F.S., or similar
 file an affidavit with the facility.
exemption, on January 1 of the year
applied for.
Include an affidavit (sample on page 2) for each qualifying
residents with this application.
DR-501CC
INDIVIDUAL AFFIDAVIT FOR AD VALOREM TAX EXEMPTION
Eff. 11/21
Page 2 of 2
PROPRIETARY CONTINUING CARE FACILITY
Section 196.1977, F.S.
COMPLETED BY EACH RESIDENT
Resident name
__
Tax Year 20
Facility name
Unit number
1. On January 1 of the current year, did you live in this unit or apartment and
Yes
No
consider it your permanent home?
2. Do you have a continuing care contract as defined in Chapter 651, F.S.?
Yes
No
3. Have you claimed homestead exemption on any other property for the
Yes
No
current year?
Under penalties of perjury, I declare that I have read the foregoing Affidavit, and that the facts stated in
it are true.
Signature, resident
Date
NOTICE TO RESIDENT
This facility must tell you how much they will save in taxes from this exemption. The facility must
lower your maintenance fee by the full amount. They must lower your fee every month, or lower your
fee one time for the entire year.
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 or a fine up to $ 5,000,
or both. (see Section 196.131(2), F.S.)
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