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

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Download this version of Form DR-501CC for the current year.

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, 2012;
  • The latest edition provided by the Florida Department of Revenue;
  • Easy to use and ready to print;
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  • Fill out the form in our online filing application.

Download a printable 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 Proprietary Continuing Care Facility" - Florida

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DR-501CC
AD VALOREM TAX EXEMPTION APPLICATION
R. 11/12
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
file an affidavit with the facility.
196.1975, F.S., or similar 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
AD VALOREM TAX EXEMPTION APPLICATION
R. 11/12
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
file an affidavit with the facility.
196.1975, F.S., or similar 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
R. 11/12
Page 2
PROPRIETARY CONTINUING CARE FACILITY
Section 196.1977, F.S.
State of Florida
County of
COMPLETED BY EACH RESIDENT
Resident name
Tax Year 20
Facility name
Unit. number
Did you live in this unit on Jan. 1 of the tax year and consider it your permanent home?
yes
No
Do you have a continuing care contract as defined in Chapter 651, F.S.?
yes
No
Have you claimed homestead exemption on any other property for the current year?
yes
No
yes
No
Did you file for tax exemptions last year?
If yes, where
If no, your last year’s address
I swear the above is true and correct. I understand that by applying for this exemption as a resident of
a proprietary continuing care facility, I may not claim any other homestead exemption for this tax year.
Signature, resident
Date
State of Florida
County of
This statement was sworn and subscribed before me this date,
by ________________________________
who is personally known to me or who has produced
as type of identification.
_______________________________________
Notary Public Signature and Seal
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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