DR-501PGP
R. 11/12
Rule 12D-16.002
Florida Administrative Code
Effective 11/12
ORIGINAL APPLICATION FOR ASSESSMENT REDUCTION FOR
LIVING QUARTERS OF PARENTS OR GRANDPARENTS
Section 193.703, Florida
Statutes
New Change Addition Due to the property appraiser by March 1.
County Parcel ID
Tax year
20
Applicant Co-applicant
Phone # Email
Address Legal description
Describe the construction or reconstruction for the living quarters
Completion date of living quarters Did you get a building permit? yes no
Parents or Grandparents Living on the Property (At least one must be age 62 or over)
Name
Marital status
single married widowed divorced single married widowed divorced
Age 62 or older?
yes no If yes, date of birth
Proof of age
yes no If yes, date of birth
Proof of age
Relationship to owner
Address last year
Did this person file tax
exemptions last year?
yes no yes no
Proof of Residence Parent/grandparent 1 Parent/grandparent 2
Last became a permanent resident of Florida
Date Date
Occupied applicant's homestead on
Date Date
Florida driver license number
# #
Florida vehicle tag number
# #
Florida voter registration number, if US citizen
# #
Declaration of Domicile residency date
Date Date
Current employer
Address on last IRS return
Addresses of parents/ grandparents
not residing on the property
Any person who makes a willfully false statement in this application will have the reduction revoked, be subject to a
penalty of up to $1,000, and be disqualified from receiving this reduction for 5 years. (s. 193.703, F.S.)
I authorize the property appraiser to obtain information to determine my eligibility for this assessment reduction. I certify that
each parent or grandparent above resided primarily on the property on January 1 and does not claim homestead exemption
in Florida or residence-based exemption or tax benefit in another state. I am a permanent resident of the State of Florida. I
own and occupy the property. I certify that I have read this application and the facts in it are true.
Signature, applicant Date Signature, qualifying parent/grandparent 1 Date
Signature, co-applicant Date Signature, qualifying parent/grandparent 2 Date
Renewal
