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Mike Wells 2022 Application for Ad Valorem Tax Exemption Pasco County Property Appraiser www.pascopa.com PAS-PA501 14236 6th St,Ste 101,Dade City,Florida 33523-3411 R-12112 Land O'Lakes(813)929-2780 New Port Richey, (727)847-8151 Dade City(352)5214433 Homestead Application Type [NIT Parcel Identification Number Cards HX card Use Mo HWDVT Pct N N=New,C=Change,A=Additional LG 14 26 210010 02300 0150 001 001 01 01 H Permanent FL residency required as of Jan 1 Name and Address M Marital Status: S, M,-W, R, D, U Use codes:A, C, 0, B, or T CURTSINGER ELWOOD&MARY N Are you receiving any residency B Homestead Exemption up to$50,000 4852 18TH ST required exemptions anywhere _$500 Widow's exemption N Rec'd Homestead within last 2 yrs? _$500 Widower's exemption ZEPHYRHILLS FL 33542 If"YES"where: _$500 (Disability) Regular Physical Address —$5000 (Disability) Service 4852 18TH ST —$5000 Surviving Spouse Notes If"NO", your last years address —$500 Blind persons exemption 1914 PRESSMENS HOME RD The following require documentation ROGERSVILLE TN 37857 _Total & Permanent disability HAWKINS SOLD exemption, Quadriplegics Ownership Information —Service connected total and Legal Description permanent disability exemption 9 p Percent of Ownership 100 Disabled veterans confined to MOORE'S FIRST ADDITION Deed date '—wheelchair PB 1 PG 57 LOTS 15& 16 Deed notary date BLOCK 23 Deed recording date _Total and permanent disability, OR 5910 PG 886 Type of deed limited income OR Book and Page —Surviving Spouse first responder NOTE:Disclosure of your Social Security number is mandatory.It is required by section 196.011 (1),Florida Statutes.The Social Security number will be used to verify taxpayer identity information,homestead exemption information submitted to property appraisers and intangible tax information submitted to the Department of Revenue. Applicant last name first MI Co-applicant last name first MI Other applicant last name first MI Proof of residence for all owners CURTSINGER ELWOOD CURTSINGER MARY Social Security No.and H,W,or O code H W — Give address for each owner not residing on above referenced property Phone number (813)355-4765 (423)923-3406 Date you became a permanent-resident of the State of Florida 02/08/2021 02/08/2021 Date of occupancy 02/08/2021 02/08/2021 Florida Drivers license number C632210503360 C632592565860 Issue date on drivers license, 02/24/2021 02/24/2021 Date of Birth 09/16/1950 03/06/1956 Florida vehicle tag,number QPIN10 TEMP TAG Florida voter registration number U.S.CITIZEN-NOT REGISTERED 111111111 Date of registration 02/24/2021 Immigration number-or-Alien Card Issue date Declaration of domicile(OR and PG) Date of registration Previous Location Current Employer RETIRED RETIRED Address listed on your last IRS return 1914 PRESSMENS HOME RD 1914 PRESSMENS HOME RD ROGERSVILLE TN 37857 ROGERSVILLE TN 37857 SOLD SOLD Location and number for out of state or foreign country drivers N/A N/A N/A N/A Location and number for out of state or N/A N/A N/A N/A foreign country vehicle registration I hereby authorize this agency to obtain information necessary to determine my eligibility for the exemption(s)applied for.Note:If all information is not received by March 1st,your application will be processed for whatever exemptions you qualify for on that date.I hereby make application for the exemptions indicated and affirm that I do qualify for same under Florida Statutes.I am a permanent resident of the State of Florida and I own and occupy the property described above. I understand that section 196.131(2)Florida Statutes provides that any person who knowingly and willfully gives false information for the purpose of claiming homestead exemption is guilty of a misdemeanor of the first degree;punishable by a term of imprisonment not exceeding 1 year or a fine not exceeding$5,000 or both.Further,under penalties or perjury,I declare that I have read the foregoing application and the facts in it are true.F.S.196.031 Exemption of homesteads—(5)"A person who is receiving or claiming the benefit of an ad valorem tax exemption or a tax credit in another state where permanent residency is required as a basis for the granting of that ad valorem tax exemption or tax credit is not entitled to the homestead exemption provided by this section." Signature of applicant Signature of Co-applicant Signature of Other Applicant Signature of Deputy 02/24/21 1:37:15 PM 02/24/21 1:37:57 PM 02/24/21 1:38:09 PM