Fill - Free fillable Feewaiver Fee Waiver Application (Hillsborough County) PDF form

Fee Waiver

Applicaon Informaon Packet

Applicaons accepted by appointment only.

Call (813) 272-5600 to schedule an appointment to le an applicaon.

All applicaons led aer 3 p.m. will be processed

and considered as led on the next business day.

The Hillsborough County Board of County Commissioners adopted lobbying ordinance

No. 93-8, as amended. Prior to meeng privately with a board member, county aorney,

chief assistant county aorney, county administrator, any assistant county administrator,

or any department head, you may be required to register as a lobbyist.

12/19/17

Fee Waiver Applicaon

Shaded Area For Ocial Use Only

Applicaon prex and number: _________ - _________ - ________________

Hearing(s) and type: Date: _______________________ Type: ___________________________

(if applicable)

Date: _______________________ Type: ___________________________

Receipt number: ___________________________

Applicaon type as referenced in LDC:_________________________________________________________________

Intake date: ____________________ Intake technician signature: __________________________________________

Applicant’s Representave

Name: ____________________________________________________________________________________________________

Address: __________________________________________________________________________________________________

City / State / Zip: _________________________________________________ Dayme phone: ( ____ ) ______________________

Email: __________________________________________________________ Fax number: ( ____ ) _________________________

Applicant

Name: ____________________________________________________________________________________________________

Address: __________________________________________________________________________________________________

City / State / Zip: _________________________________________________ Dayme Phone: ( ____ ) _____________________

Email: __________________________________________________________ Fax number: ( ____ ) _________________________

Property Owner

Name: ____________________________________________________________________________________________________

Address: __________________________________________________________________________________________________

City / State / Zip: _________________________________________________ Dayme Phone: ( ____ ) _____________________

Email: __________________________________________________________ Fax number: ( ____ ) _________________________

Property address or general locaon: ____________________________________________________________________________

__________________________________________________________________________________________________________

Nature of request: __________________________________________________________________________________________

Related applicaons: _________________________________________________________________________________________

Proposed ulies: public water_______ private well_______ public wastewater_______ sepc tank_______

(Addional informaon required on “Property Informaon Sheet”)

I hereby swear or arm that all the informaon

provided in the submied applicaon packet is true

and accurate, to the best of my knowledge, and

authorize the representave listed above to act on

my behalf on this applicaon.

___________________________________________________________________

Signature of the Applicant

___________________________________________________________________

Type or print name

I hereby authorize the processing of this applicaon

and recognize that the nal acon taken on this peon

shall be binding to the property as well as to the current

and any future owners.

___________________________________________________________________

Signature of the Owner(s) – (All pares on the deed must sign)

___________________________________________________________________

Type or print name

Development Services

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signature

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signature

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signature

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Adavit of Financial Hardship

STATE OF FLORIDA

COUNTY OF HILLSBOROUGH

I HEREBY CERTIFY, that on this day, before me, an ocer duly authorized in the State aforesaid and in the County aforesaid to

take acknowledgments, personally appeared, _____________________________________________________________ ,

who is either personally known to me ________ or produced _______________________________________________

as idencaon, 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 ocial seal in the County and State last aforesaid this ________ day of ___________________ 20____ .

__________________________________________________

NOTARY PUBLIC

My commission expires:

STATE OF FLORIDA

COUNTY OF HILLSBOROUGH

BEFORE ME, the undersigned authority personally appeared, _____________________________________________,

who, being rst duly cauoned and sworn, deposes and says:

1. That my name is ______________________________________________________ and I make this adavit based

upon my personal knowledge.

2. That I am the authorized representave of __________________________________________________________,

a non-prot organizaon cered by the Internal Revenue Service as a 501(c)3 organizaon.

3. I do hereby cerfy that due to nancial hardship, the above-referenced organizaon is in need of a waiver of the

applicable fee(s) for the aached land use applicaon.

FURTHER AFFIANT SAYETH NAUGHT. ____________________________________________________

Signature of Aant

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Secon 9.0

Administrave Determinaons

A. General Descripon

This secon includes submial and review procedures for administrave determinaons for the following:

- Interpretaons of the Land Development Code (LDC)

- Non-Conformies

- Minor Changes to General Development Plans

- General Site Plan Cercaons

- Zoning Vericaons

- Administrave Waivers

- Fee Waivers

B. Review Procedures

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

determinaons:

1. Determinaon of Completeness: Within seven (7) business days (excluding County holidays) of receiving the

applicaon, the Administrator shall determine whether the request is complete. If the Administrator determines

that the request is not complete, verbal or wrien noce shall be given to the applicant specifying the deciencies.

If the deciencies are not remedied within 30 days of receipt of the nocaon, a determinaon will be rendered

based on the informaon provided.

2. Rendering of Interpretaon: Within thirty (30) business days (excluding County holidays) of receiving the

applicaon, the Administrator shall review and evaluate the request. The determinaon shall be in wring and

shall be sent to the applicant

C. Appeals

Administrave determinaons may be appealed to the Land Use Hearing Ocer (LUHO) pursuant to the procedures

in Secon 10.0 of the manual (Appeals From The Administrator To The LUHO), unless otherwise required.

Sec. 9.7

Fee Waivers

In addion to the general submial requirements, the following supplemental submial requirements and review

informaon for fee waiver applicaons shall apply.

A. General Descripon

This is a process to consider the waiver or refund of certain types of land use or development review applicaon fees.

This process does not include impact fees and ulity capacity fees.

Requests for fee waivers may be considered when necessitated due to nancial hardship, sta error or emergency/

catastrophe. There are two types of fee waiver requests: Personal and Non- Prot Organizaon.

Applicaons will be reviewed by the Administrator in accordance with the criteria herein. Applicaons which cannot

be approved by the Administrator will be automacally scheduled for review by the Land Use Hearing Ocer for

consideraon of an Excepon to the criteria unless the peoner requests the applicaon be withdrawn

B. Cross Reference to Land Development Code

None

C. Submial Requirements

1. Personal Requests - Proof of nancial hardship is required to be submied by the applicant, spouse and all

proposed beneciaries 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 informaon 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 le an Income Tax Return, other proof of previous year’s income, such as Form SSA-1099 (Social Security

Benet 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. Wrien statement describing the fees to be waived and the nature of the nancial hardship.

2. Non-Prot Organizaon Requests – The applicant shall provide the following informaon:

a. Proof of an exisng contract for the organizaon to provide social services on behalf of the BOCC resulng

from either parcipaon in the County’s biennial compeve or non-compeve Request-for-Applicaon

(RFA) process, or as a result of having been previously selected by the BOCC through a compeve process to

provide County social services.

b. Proof of cercaon by the Internal Revenue Service as a 501(c)3 non-prot organizaon.

c. A statement cerfying the organizaon does not discriminate on the basis of age, race, color, sex, religion,

handicap, marital status or naonal origin.

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

e. A completed Adavit of Financial Hardship found in Secon 3.0 of this manual.

f. A wrien statement describing the fees to be waived and the nature of the nancial hardship. No other

evidence of nancial hardship shall be required.

D. General Review Process

Fee waiver applicaons which are in accord with the submial and review criteria herein shall be approved by the

Administrator within 30 business days. For applicaons which cannot be approved, the Administrator shall schedule

the applicaon for review by the Land Use Hearing Ocer (LUHO) to consider an Excepon and shall nofy the

peoner of the hearing date in wring, at which me the peoner may request the applicaon be withdrawn.

1. LUHO Review – At the hearing, the peoner shall be responsible for providing tesmony to the LUHO regarding

the merits of the case. The LUHO may consider the applicaon for approval in the form of an Excepon to the

criteria. Excepon requests shall be reviewed in a non-noced proceeding and the LUHO shall render a wrien

decision within 5 working days of the proceeding. If the Excepon is denied by the LUHO, the decision is nal and

may not be appealed.

E. Administrave Review Criteria for Personal Requests

Fee waivers shall not be approved by the Administrator when the request is in connecon with commercial

businesses, for-prot enterprises, real estate speculaon, 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 beneciary 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 nancial hardship for land use applicaons under the following circumstances:

a. Applicaons aecng the applicant’s homestead.

b. Applicaons aecng property the applicant proposes to homestead, provided the size of property does not

greatly exceed the minimum required by zoning and/or ulies to preclude future subdivision of the property.

c. Applicaons that will allow a member of the applicant’s immediate family to homestead the property or

subdivided poron thereof.

F. Administrave Review Criteria for Non-Prot Organizaon Requests

Requests for fee waivers by non-prot agencies shall be considered only if the organizaon meets the requirements

of Secon 9.7.C.2 herein. Such requests shall be reviewed on the basis of the documentaon submied in

accordance with said secon, including the Adavit of Financial Hardship, without need for further evidence of

nancial hardship.

G. LUHO Review Criteria for Excepons

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

consideraon of an Excepon, unless the request is withdrawn by the peoner. The LUHO shall conduct an

independent review of the request based on the criteria herein and the tesmony at the proceeding. In granng an

Excepon, the LUHO shall be required to nd extraordinary nancial circumstances, emergency, catastrophe or sta

error which are outside the scope of the Administrator’s authority to consider.

Checklist of Submial Requirements for a Fee Waiver

(Personal Request)

Applicant

Inials

Intake

Inials

Requirements

Applicaon (Included in this packet)

Wrien Statement describing the fees to be waived and the nature of the nancial

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 le an Income Tax Return, other proof of previous year’s income, such as

Form SSA-1099 (Social Security Benet 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 Submial Requirements for a Fee Waiver

(Non-Prot Organizaon Request)

Applicant

Inials

Intake

Inials

Requirements

Applicaon (Included in this packet)

Wrien Statement describing the fees to be waived and the nature of the nancial

hardship

3. Adavit of Financial Hardship

3.a.

- Proof of an exisng contract for the organizaon to provide social services on

behalf of the BOCC resulng from either parcipaon in the County’s biennial

compeve or non-compeve Request-for-Applicaon (RFA) process, or as a

result of having been previously selected by the BOCC through a compeve

process to provide County social services.

3.b.

- Proof of cercaon by the Internal Revenue Service as a 501(c)3 non-prot

organizaon.

3.c.

- Statement cerfying the organizaon does not discriminate on the basis of age,

race, color, sex, religion, handicap, marital status or naonal origin.

3.d.

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

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Fillable Feewaiver Fee Waiver Application (Hillsborough County)

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