Get Form Dr-416 - Broward County Property Appraiser's Network - Leonpa

This guide provides clear instructions on how to complete the Form DR-416 for individuals seeking a total and permanent disability exemption in Broward County. By following the steps outlined here, users can efficiently fill out the form online.

Follow the steps to complete the Form DR-416 online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Enter the patient's name in the designated field, ensuring it is printed clearly to avoid confusion.
3. In the section for certification, the physician must indicate their name and circle the appropriate title for the patient (Mr., Mrs., Miss, Ms.). This helps to officially identify the individual applying for the exemption.
4. Input the patient's Social Security number, as this is required for identification and verification purposes.
5. Specify the date the patient is considered to be totally and permanently disabled. This is crucial to establish eligibility for the exemption.
6. Select the type of disability from the options provided, such as quadriplegia, paraplegia, hemiplegia, legal blindness, or other permanent disabilities. If the individual does not require a wheelchair for mobility but is still considered disabled, check the appropriate box.
7. The physician must sign and date the form, confirming their professional belief about the patient's condition. Include the physician’s address and licensing details, as this ensures the legitimacy of the certification.
8. Review the entire form for accuracy and completeness before finalizing. This helps prevent delays in processing.
9. After ensuring all information is correctly filled in, save any changes made. You can download, print, or share the completed form as needed.

Complete your Form DR-416 online today to secure your total and permanent disability exemption.