Fill - **Applications Accepted By Appointment Only** (Hillsborough County)

FEE WAIVER

APPLICATION INFORMATION PACKET

**Applications Accepted By Appointment Only**

Call 813-272 5600 to schedule an appointment to file an

application. All applications filed after 3:00 p.m. will be

processed and considered as filed on the next business day.

THE HILLSBOROUGH COUNTY BOARD OF COUNTY COMMISSIONERS

ADOPTED LOBBYING ORDINANCE NO. 93-8, AS AMENDED. PRIOR TO

MEETING PRIVATELY WITH A BOARD MEMBER, COUNTY ATTORNEY,

CHIEF ASSISTANT COUNTY ATTORNEY, COUNTY ADMINISTRATOR, ANY

ASSISTANT COUNTY ADMINISTRATOR, OR ANY DEPARTMENT HEAD,

YOU MAY BE REQUIRED TO REGISTER AS A LOBBYIST.

REVISED 4-21-2014

HILLSBOROUGH COUNTY DEVELOPMENT SERVICES DEPARTMENT

FEE WAIVER APPLICATION

Shaded Area For Official Use Only

APPLICATION PREFIX & NUMBER: - -

HEARING(S) & TYPE: DATE: TYPE:

(If Applicable)

DATE: TYPE:

RECEIPT NUMBER:

REVISED 4-21-2014

APPLICATION TYPE AS REFERENCED IN LDC:

INTAKE DATE: INTAKE TECHNICIAN SIGNATURE:

APPLICANT’S REPRESENTATIVE

Name:

Address:

City / State / Zip: Daytime Phone: ( )

E-mail Address: Fax Number: ( )

APPLICANT

Name:

Address:

City / State / Zip: Daytime Phone: ( )

E-mail Address: Fax Number: ( )

PROPERTY OWNER

Name:

Address:

City / State / Zip: Daytime Phone: ( )

E-mail Address: Fax Number: ( )

PROPERTY ADDRESS OR GENERAL LOCATION:

NATURE OF REQUEST:

RELATED APPLICATIONS:

PROPOSED UTILITIES: Public Water Private Well Public Wastewater Septic Tank

(Additional Information Required On “Property Information Sheet”)

I HEREBY SWEAR OR AFFIRM THAT ALL THE

INFORMATION PROVIDED IN THE SUBMITTED

APPLICATION PACKET IS TRUE AND ACCURATE, TO

THE BEST OF MY KNOWLEDGE, AND AUTHORIZE

THE REPRESENTATIVE LISTED ABOVE TO ACT ON

MY BEHALF ON THIS APPLICATION.

Signature of the Applicant

Type or Print Name

I HEREBY AUTHORIZE THE PROCESSING OF THIS

APPLICATION AND RECOGNIZE THAT THE FINAL

ACTION TAKEN ON THIS PETITION SHALL BE

BINDING TO THE PROPERTY AS WELL AS TO THE

CURRENT AND ANY FUTURE OWNERS.

Signature of the Owner

Type or Print Name

Page 1 of 2

AFFIDAVID OF FINANCIAL HARDSHIP

STATE OF FLORIDA

COUNTY OF HILLSBOROUGH

BEFORE ME, the undersigned authority personally appeared, ,

who, being first duly cautioned and sworn, deposes and says:

1. That my name is and I make this affidavit based

upon my personal knowledge.

2. That I am the authorized representative of , a

non-profit organization certified by the Internal Revenue Service as a 501(c)3 organization.

3. I do hereby certify that due to financial hardship, the above-referenced organization is in

need of a waiver of the applicable fee(s) for the attached land use application.

FURTHER AFFIANT SAYETH NAUGHT.

Signature of Affiant

STATE OF FLORIDA

COUNTY OF HILLSBOROUGH

I HEREBY CERTIFY, that on this day, before me, an officer duly authorized in the State

aforesaid and in the County aforesaid to take acknowledgements, personally appeared,

, who is either personally known to me or produced

as identification, to me known to be the person described in and

who executed the aforesaid instrument, and he/she acknowledged before me that he/she executed same as

his/her free act and deed for the uses and purposes therein stated.

WITNESS my hand and official seal in the County and State last aforesaid this day of

20 .

NOTARY PUBLIC

My Commission Expires:

REVISED 4-21-2014

SECTION 9.0

ADMINISTRATIVE DETERMINATIONS

A. General Description

This section includes submittal and review procedures for administrative determinations for the

following:

- Interpretations of the Land Development Code (LDC)

- Non-Conformities

- Minor Changes to General Development Plans

- General Site Plan Certifications

- Zoning Verifications

- Administrative Waivers

- Fee Waivers

B. Review Procedures

Unless otherwise required, the following review procedures shall be followed for review of

administrative determinations:

1. Determination of Completeness: Within seven (7) business days (excluding County

holidays) of receiving the application, the Administrator shall determine whether the

request is complete. If the Administrator determines that the request is not complete,

verbal or written notice shall be given to the applicant specifying the deficiencies. If the

deficiencies are not remedied within 30 days of receipt of the notification, a

determination will be rendered based on the information provided.

2. Rendering of Interpretation: Within thirty (30) business days (excluding County

holidays) of receiving the application, the Administrator shall review and evaluate the

request. The determination shall be in writing and shall be sent to the applicant.

C. Appeals

Administrative determinations may be appealed to the Land Use Hearing Officer (LUHO)

pursuant to the procedures in Section 10.0 of the manual (Appeals From The Administrator To

The LUHO), unless otherwise required.

Sec. 9.7

FEE WAIVERS

In addition to the general submittal requirements, the following supplemental submittal requirements

and review information for fee waiver applications shall apply.

A. General Description

This is a process to consider the waiver or refund of certain types of land use or development

review application fees. This process does not include impact fees and utility capacity fees.

Requests for fee waivers may be considered when necessitated due to financial hardship, staff

error or emergency/ catastrophe. There are two types of fee waiver requests: Personal and Non-

Profit Organization.

Applications will be reviewed by the Administrator in accordance with the criteria herein.

Applications which cannot be approved by the Administrator will be automatically scheduled

for review by the Land Use Hearing Officer for consideration of an Exception to the criteria

unless the petitioner requests the application be withdrawn.

B. Cross Reference to Land Development Code

None

C. Submittal Requirements

1. Personal Requests - Proof of financial hardship is required to be submitted by the

applicant, spouse and all proposed beneficiaries of the review process for which the fee

waiver is sought, for example, a member of the applicant's immediate family who is to

receive or purchase a lot from the subdivision of property that is the subject of the

waiver. The following information shall be provided:

a. Current wage earnings statement.

b. Previous year's U.S. Individual Income Tax Return statement(s). In cases where

an applicant was not required to file an Income Tax Return, other proof of

previous year's income, such as Form SSA-1099 (Social Security Benefit

Statement), shall be provided.

c. Current bank account statements (savings and checking)

d. Debt statement, excluding credit card debts.

e. Summary of monthly expenses

f. Written statement describing the fees to be waived and the nature of the

financial hardship.

2. Non-Profit Organization Requests – The applicant shall provide the following

information:

a. Proof of an existing contract for the organization to provide social services on

behalf of the BOCC resulting from either participation in the County’s biennial

competitive or non-competitive Request-for-Application (RFA) process, or as a

result of having been previously selected by the BOCC through a competitive

process to provide County social services.

b. Proof of certification by the Internal Revenue Service as a 501(c)3 non-profit

organization.

c. A statement certifying the organization does not discriminate on the basis of age,

race, color, sex, religion, handicap, marital status or national origin.

d. Proof of licensing by the State of Florida and Hillsborough County, as

appropriate.

e. A completed Affidavit of Financial Hardship found in Section 3.0 of this manual.

f. A written statement describing the fees to be waived and the nature of the

financial hardship. No other evidence of financial hardship shall be required.

04/21/2014

REVISED 04-21-2014

D. General Review Process

Fee waiver applications which are in accord with the submittal and review criteria herein shall

be approved by the Administrator within 30 business days. For applications which cannot be

approved, the Administrator shall schedule the application for review by the Land Use Hearing

Officer (LUHO) to consider an Exception and shall notify the petitioner of the hearing date in

writing, at which time the petitioner may request the application be withdrawn.

1. LUHO Review

– At the hearing, the petitioner shall be responsible for providing

testimony to the LUHO regarding the merits of the case. The LUHO may consider the

application for approval in the form of an Exception to the criteria. Exception requests

shall be reviewed in a non-noticed proceeding and the LUHO shall render a written

decision within 5 working days of the proceeding. If the Exception is denied by the

LUHO, the decision is final and may not be appealed.

E. Administrative Review Criteria for Personal Requests

Fee waivers shall not be approved by the Administrator when the request is in connection with

commercial businesses, for-profit enterprises, real estate speculation, the subdivision of

property for the market sale of lots and similar ventures.

The Administrator shall approve fee waivers when the request is in accord with the following

criteria:

1. The household income of the applicant or the household income of the beneficiary of

the review process for which the fee waiver is sought, whichever is greater, does not

exceed 80 percent of median income or below taken from the Federal Housing and

Urban Development (HUD) Area Median Income Chart for Hillsborough County.

2. The request is to relieve personal financial hardship for land use applications under the

following circumstances:

a. Applications affecting the applicant’s homestead.

b. Applications affecting property the applicant proposes to homestead, provided

the side of property does

c. Applications that will allow a member of the applicant’s immediate family to

homestead the property or subdivided portion thereof.

F. Administrative Review Criteria for Non-Profit Organization Requests

Requests for fee waivers by non-profit agencies shall be considered only if the organization

meets the requirements of Section 9.7.C.2 herein. Such requests shall be reviewed on the basis

of the documentation submitted in accordance with said section, including the Affidavit of

Financial Hardship, without need for further evidence of financial hardship.

G. LUHO Review Criteria for Exceptions

All fee waiver requests not approved by the Administrator shall be scheduled for review by the

LUHO for consideration of an Exception, unless the request is withdrawn by the petitioner.

The LUHO shall conduct an independent review of the request based on the criteria herein and

the testimony at the proceeding. In granting an Exception, the LUHO shall be required to find

extraordinary financial circumstances, emergency, catastrophe or staff error which are outside

the scope of the Administrator’s authority to consider.

REVISED 4-21-2014

Checklist of Submittal Requirements for a Fee Waiver

(Personal Request)

Applicant Intake

Initials Initials Requirements

1. ________ ________ Application (Included in this packet)

2. ________ ________ Written Statement describing the fees to be waived and the

nature of the financial hardship.

3. ________ ________ Proof of Financial Hardship

3.a. ________ ________ *Current wage earnings statement (applicant and spouse)

3.b. ________ ________ *Previous year’s tax statement in cases where an applicant was

not required to file an Income Tax Return, other proof of

previous year’s income, such as Form SSA-1099 (Social Security

Benefit Statement), shall be provided.

3.c. ________ ________ *Current bank account statements (savings and checking)

3.d. ________ ________ *Debt statement, excluding credit card debts

3.e. ________ ________ *Summary of monthly expenses

Checklist of Submittal Requirements for a Fee Waiver

(Non-Profit Organization Request)

Applicant Intake

Initials Initials Requirements

1. ________ ________ Application (Included in this packet)

2. ________ ________ Written Statement describing the fees to be waived and the

nature of the financial hardship.

3.a. ________ ________ Affidavit of Financial Hardship

3.b. ________ ________ Proof of an existing contract for the organization to provide

social services on behalf of the BOCC resulting from either

participation in the County’s biennial competitive or non-

competitive Request-for-Application (RFA) process, or as a

result of having been previously selected by the BOCC through a

competitive process to provide County social services.

3.c. ________ ________ Proof of certification by the Internal Revenue Service as a

501(c)3 non-profit organization.

3.d. ________ ________ Statement certifying the organization does not discriminate

on the basis of age, race, color, sex, religion, handicap, marital

status or national origin.

3.e. ________ ________ Proof of licensing by the State of Florida and Hillsborough

County, as appropriate.

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