G:\Zoning 2009\Forms and Sample documents\Website Documents\BTR\Applications\ fee_ex_app.pdf Modified: 10.22.2019
City of Pompano Beach
Department of Development Services
Business Tax Receipt Division
100 W. Atlantic Blvd Pompano Beach, FL 33060
Fee Exemption Application
Phone: 954.786.4668 / 954.786.4633 Fax: 954.786.4666
Applicants for exemption under city ordinance 113.28 of Pompano Beach &/or 205.055 of the Florida Statutes must
complete the following & provide written documentation in support of his or her request:
1. A veteran of the United States Armed Forces who was honorably discharged upon separation from
service, or the spouse or unremarried surviving spouse of such a veteran.
2. The spouse of an active duty military servicemember who has relocated to the county or municipality
pursuant to a permanent change of station order.
3. A person who is receiving public assistance as defined in s. 409.2554.
4. A person whose household income is below 130 percent of the federal poverty level based on the
current year’s federal poverty guidelines.
5. Physically disabled (Physician’s Certificate)
6. Widows with minor dependents.
7. Persons 65 Years of age or older,
with not more than one employee or helper
own capital only (not in excess of $1,000.00)
8. Not for profit group. (Proof of non-profit status required)
Name of Applicant _________________________________________________ Date:__________________
Home Address _____________________________________________________________________________
Phone _________________________ Date of Birth ________________________ Age __________________
IT IS HEREBY AGREED THAT THE ABOVE IS THE TRUTH TO THE BEST OF MY KNOWLEDGE.
__________________________________________
SIGNATURE OF PERSON MAKING REQUEST
SWORN TO AND SUBSCRIBED before me this ____ day of ________________ , _______,
at Pompano Beach, Broward County Florida.
___________________________________________________
Notary Public, State of Florida
___ Personally Known ___ Produced Identification
Type of Identification Produced: ___________________________________
FOR STAFF USE ONLY (DO NOT WRITE BELOW THIS LINE)
Reviewed by:
Approved:
Denied:
Date:
Process Number:
Comments:
Notary Public
Seal of Office
