SOLID WASTE ASSESSMENT ACCESSORY DWELLING
DISABILITY EXEMPTION APPLICATION
TAX YEAR 2020
Folio #
Tax year 2020
(Collection / Disposal Service Period)
January 1 – December 31, 2020
Describe Additional Dwelling Use:
The primary dwelling must be homesteaded by the applicant. The accessory dwelling must be occupied by a natural or adoptive parent,
grandparent, great grandparent, child, stepchild, grandchild or sibling of one of the parcel owner(s). Such occupant must be eighteen (18)
years of age or older and must obtain from a physician a certificate stating that such occupant has a disability requiring assistance with
daily living activities. The accessory dwelling must be separate from the single family residence and not greater than 900 square feet unless
a variance is approved.
PHYSICIAN CERTIFICATION:
I certify that Mr. /Mrs. /Ms. (please print) __________________________________________ has a disability requiring
assistance with daily living activities. The foregoing statement is true, correct, and complete to the best of my knowledge
and my professional belief.
_________________________________________ ___________________________
Physician’s Signature Date
__________
_______________________________ ___________________________
Print Physician’s Name License #
DISABLED EXEMPTION CERTIFICATION:
I_______
_________________________________________ hereby attest that I reside at the accessory dwelling above and
have a disability requiring assistance with daily living activities.
Signature ____________________________________________ Date ___________
No per
son shall make any willfully false statement in the application for an exemption of the solid waste non-ad valorem
collection and disposal assessments. If the owner of the accessory dwelling unit for which an exemption is granted is found
to have made any willfully false statement in the application for the exemptions, the exemptions shall be revoked and the
owner may be subject to prosecution in the same manner as a misdemeanor pursuant to Florida Law.
Please
mail the signed physician and exemption certification to:
Hil
lsborough County Public Utilities Department
Attention: Solid Waste Assessments
PO Box 342456
Tampa, Florida 33694
Solid Waste Staff Review Date / Initials: _________________ /_________
Applications for the current tax year must be received by May 1 to appear on the tax bill you will receive this November; any applications
received on or after May 1 will appear on the tax bill for next year in November of next year.
