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Mike Wells Ori inal 2014 Application forAd Valorem Tax Exemption Pasco Countv Propertv Appraiser http:llappraiser.pascogov.com PAS-PA501 14236 6th St,Ste 101,Dade City,Florida 33523-3411 Dade City(352)521-4433 R-�Z�Z • FGORID� Land O'lakes(813)929-2780 New Port Richey/Gulf Harbors(727)847-8151 Homestead Application Type INIT � Parcel Identification Number Cards HX card Use Mo HWDV Pct N N=New,C=Change,A=Additional CL___ 10 26 21 0120 00000 0930 001 001 _ 01 01 pe�manent FL residency required as of Jan 1 Name and Address _M Marital Status:S,M,W, R, D,U Use codes:A,C,O,B,or T KIZER BRADLEY J SR&BEVERLY J N Are you receiving any residency B Homestead Exemption up to$50,000 required exemptions anywhere g500 Widow's exemption 37345 DERBYSHIRE DR N Rec'd Homestead within last 2 rs? __ y $500 Widower's exemption ZEPHYRHILLS FL 33542 If"YES"where: _$500(Disability)Regular Physical Address -- $5000(Disability)Service 37345 DERBYSHIRE DR ------------ i$5000 Surviving Spouse Notes If"NO",your last years address —$500 Blind persons exemption DRAKE CT-BLUEJAY MHP The following require documentation PF-11 DADE CITY FL � Total 8 Permanent disability PASCO RENTED �exemption,Quadriplegics Ownership Information _Service connected total and Legal Description permanent disability exemption Percent of Ownership 100 Disabled veterans confined to WEDGEWOOD MANOR PHASE I&II Deed date 01/14i2013 ---Wheelchair PB 27 PG 11-14 Deed notary date 01/�4i2013 Total and ermanent disabili LOT 93 Deed recording date 00/00/0000 — p �� OR 3809 PGS 950-952 Type of deed WD ` limited income OR Book and Page 0000-0000 —Surviving Spouse first responder NOTE.Disclosure of your Social Security number is mandatory It is required by section 196.011(1),F'lorida Statutes.The Social Security number will be used to verity taxpayer identity information,homestead exemption informatian submitted to property appraisers and intangible tax information submitted to the DepaRment 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 KIZER BRADLEY J SR KIZER BEVERLY J Social Security No.and H,W,or O code H �--'---y�/ v--^�_��—_ Give address for each owner not residing on above referenced property �^ � Phone number (813)395-6269 (813)395-6269 Date you became a pertnanent resident ^ V of the State of Plorida 00/00/2005 00/00l2005 Date ofoccupancy 01/14/2013 01/14/2013 Florida Drivers license number K260070360240 K260070369160 Issue date on drivers license 11/30/2011 11/01/2011 � � � Date of Birth 01/24/1936 11/16/1936 � Florida vehicle tag number AQGV68 N/A Florida voter registration number PASCO PASCO Date of registration 00J00/0000 00/00/0000 ^ � Immigration number-or-Alien Card N/A N/A Issue date -- —- -- -- ------------ ---------- Declaration of domicile(OR and PG) N!A N/A ` Date of registration ----- -- — -- ----— — --i-----�------l�- Previous Location � Current Employer RETIRED RETIRED Address listed on your last IRS return DRAKE CT-BLUEJAY MHP DRAKE CT-BLUE.IAY MHP DADE CITY FL DADE CITY FL. � � RENTED RENTED ` � � Location and number for out of state or � foreign country drivers N/A N/A N!A N/A ___ __ `_ __ Location and�umber for out af state or N/A N/A N/A N/A foreign country vehicle registretion ----- ------ —---- -- -- - ----------------------- I hereby authorize this agency to obtain infortnation necessary to determine my eligibility for the exem�tion(s)applied for Note:If all informatian is not received by March 1st,your applicatian 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 misdemeanar of the first degree,punishable by a term of imprisonment not exceeding t year or a fine not exceeding$5,000 or both.Further,under penalties or perjury,I deGare that I have read the foregoing application and the fads 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." �� a�`�" � ��.�. Signature of applicant Signature of Co-applicant Signature of Other Applicant Signature of Deputy 2/20l13 12:02:29 PM 2/20l13 12:03:07 PM 2/20/13 12:03:20 PM C