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Florida First Responder Disability Physician Form

Florida first responders totally and permanently disabled by a line-of-duty injury can claim a full homestead property tax exemption under section 196.102, Florida Statutes. The statute requires physician certificates, and the Department of Revenue publishes this sample Word document for the physician to certify the impairment and its lifelong effect.

Who completes it

A physician licensed under chapter 458 or 459 completes and signs the whole certificate, listing the applicant's mental or physical conditions and Social Security number, plus a Florida Board of Medicine or Osteopathic Medicine license number and issue date.

Submitting and payment

How to submit it
The physician gives the certificate to the applicant, who presents it to the county property appraiser with the required Social Security Administration documentation and the employer's certification of injury.
Who pays
The Department of Revenue sets no fee and the certificate does not say who pays the physician.

Good to know

  • The physician certifies, within a reasonable degree of medical certainty, that the impairment prevents any substantial gainful occupation and is reasonably certain to continue throughout the applicant's life.
  • Section 196.102(5) requires the physician certificates, SSA documentation and an employer certificate showing the applicant worked as a first responder when injured.
  • It is a sample document rather than a numbered DR form, and the Department also posts a sample employer certification of injury.
  • Section 196.102(10) makes knowingly giving false information to claim this exemption a first-degree misdemeanor.

Get the official form

Download the current version from the source each time; forms change without notice.

First Responder's Physician Certificate of Total and Permanent Disability

Official pageWord file

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How this list is checked

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Frequently asked questions

Who can sign Florida's first responder physician certificate?

A physician licensed under chapter 458 (medicine) or chapter 459 (osteopathic medicine), Florida Statutes. The physician lists a Florida Board of Medicine or Osteopathic Medicine license number and issue date. Other professions are not named on this certificate.

What must the physician certify for the first responder exemption?

That the applicant is totally and permanently disabled by an impairment of mind or body that makes them unable to engage in any substantial gainful occupation and is reasonably certain to continue throughout life, along with a list of the mental or physical conditions involved.

Does the physician certificate need to say the injury happened on duty?

The certificate does not ask about the injury's circumstances. Line-of-duty status is documented by the separate employer certification of injury, which the applicant presents to the property appraiser with the physician certificates and SSA documentation under section 196.102(5).