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Get FL DR-501A 2020-2024

DR-501A R. 11/12 STATEMENT OF GROSS INCOME Rule 12D-16. 002 Florida Administrative Code Effective 11/12 Section 196. 101 4 c Florida Statutes Date Applicants for the Exemption for Totally and Permanently Disabled Persons Section 196. 101 F*S* must complete sign and attach this statement to the exemption application Form DR-501. Applicant name Address of homestead Parcel ID Name of all other persons living at the homestead Gross Income Include the incomes of all persons above. Attach last year s Federal Income Tax Returns and Wage and Income Statements W-2 for all persons above. HOUSEHOLD GROSS INCOME FOR THE YEAR 20 Earned income Income from investments Gains from disposition of appreciated property Interest Rents Royalties Dividends Annuities Social security benefits Veterans Administration benefits Income from retirement plans Pensions Trusts Estates Inheritances Direct and indirect gifts Other specify TOTAL GROSS INCOME I certify this Statement of Gross Income is true and correct to the best of my knowledge. State of Florida County of Signature applicant This instrument was sworn to and subscribed before me this date by who is personally known to me or who has produced as identification* Type of ID Notary public signature and seal Add pages if needed*. 101 4 c Florida Statutes Date Applicants for the Exemption for Totally and Permanently Disabled Persons Section 196. 101 F*S* must complete sign and attach this statement to the exemption application Form DR-501. Applicant name Address of homestead Parcel ID Name of all other persons living at the homestead Gross Income Include the incomes of all persons above. 101 F*S* must complete sign and attach this statement to the exemption application Form DR-501. Applicant name Address of homestead Parcel ID Name of all other persons living at the homestead Gross Income Include the incomes of all persons above. Attach last year s Federal Income Tax Returns and Wage and Income Statements W-2 for all persons above. Attach last year s Federal Income Tax Returns and Wage and Income Statements W-2 for all persons above. HOUSEHOLD GROSS INCOME FOR THE YEAR 20 Earned income Income from investments Gains from disposition of appreciated property Interest Rents Royalties Dividends Annuities Social security benefits Veterans Administration benefits Income from retirement plans Pensions Trusts Estates Inheritances Direct and indirect gifts Other specify TOTAL GROSS INCOME I certify this Statement of Gross Income is true and correct to the best of my knowledge. HOUSEHOLD GROSS INCOME FOR THE YEAR 20 Earned income Income from investments Gains from disposition of appreciated property Interest Rents Royalties Dividends Annuities Social security benefits Veterans Administration benefits Income from retirement plans Pensions Trusts Estates Inheritances Direct and indirect gifts Other specify TOTAL GROSS INCOME I certify this Statement of Gross Income is true and correct to the best of my knowledge. State of Florida County of Signature applicant This instrument was sworn to and subscribed before me this date by who is personally known to me or who has produced as identification* Type of ID Notary public signature and seal Add pages if needed*.

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