Florida homeowners claiming the total and permanent disability property-tax exemptions under s. 196.101 need this physician certificate. Clinicians meet it when a patient with quadriplegia, paraplegia, hemiplegia, legal blindness or another wheelchair-dependent disability applies to the county property appraiser. The patient files the signed form with the appraiser, usually alongside the homestead application on Form DR-501, and the appraiser decides the exemption.
A physician licensed under Chapter 458 (MD) or Chapter 459 (DO), Florida Statutes, completes and signs the entire form. The patient supplies their Social Security number, which the form marks as mandatory, and files the certificate.
The form opens as a first-person certification: 'I, [physician's name], a physician licensed pursuant to Chapter 458 or Chapter 459, Florida Statutes.' Enter your full name as it appears on your Florida license. The notice at the bottom states that each form is to be completed by a licensed Florida physician, so a doctor licensed only in another state cannot certify on it.
Check Mr., Mrs., Miss or Ms., enter the patient's Social Security number in the three boxes, and print the name of the totally and permanently disabled person. The footnote explains that disclosure of the SSN is mandatory under ss. 196.011(1) and 196.101(5), F.S., and that appraisers use it to verify taxpayer identity and homestead exemption information.
Complete the year in the sentence stating the person is totally and permanently disabled as of January 1, then check the condition or conditions: quadriplegia, paraplegia, hemiplegia, legal blindness, or other total and permanent disability requiring use of a wheelchair for mobility. The boxes follow s. 196.101: a quadriplegic owner's homestead is fully exempt, while the other listed conditions qualify subject to the household income limit.
A separate box reads 'Check here if patient is totally or permanently disabled but does not require a wheelchair for mobility.' Use it when the patient is totally and permanently disabled without wheelchair dependence. Such a certificate supports the separate disability exemption under s. 196.202, F.S., which the owner claims on the homestead application, Form DR-501.
Repeat the patient's title and name in the closing statement that, in your professional belief, the condition renders the person totally and permanently disabled and that the statements are true, correct and complete. Sign and date the form. The notice below warns that knowingly giving false information to claim homestead exemption is a first-degree misdemeanor under s. 196.131(2), F.S.
Print your street, city, state and ZIP, then your Florida Board of Medicine or Osteopathic Medicine license number and the date it was issued. The appraiser uses this block to confirm the certifying physician holds a qualifying Florida license, which is what makes the certificate count toward the two-physician requirement.
Download the current version from the source each time; forms change without notice.
Physician's Certification of Total and Permanent Disability
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Sources for this guide
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Only a physician licensed under Chapter 458 or Chapter 459, Florida Statutes, meaning a Florida-licensed MD or DO. The form asks for the Florida Board of Medicine or Osteopathic Medicine license number and its issue date. For legal blindness, a Florida-licensed optometrist can certify on the separate Form DR-416B as one of the two required certificates.
Yes. The notice on the form says an applicant may present either a copy of the DR-416 or a letter from the U.S. Department of Veterans Affairs to the county property appraiser. The Department of Revenue's PT-111 guide also allows a VA certificate instead of the two Florida physicians' certificates for first-time filers.
The form's notice to taxpayers says each Florida resident applying for a total and permanent disability exemption must present the certificate, or a VA letter, to the county property appraiser on or before March 1 of each year. The appraiser decides whether the parcel qualifies; a denial can be petitioned to the county value adjustment board.