The First Responder’s Physician Certificate of Total and Permanent Disability is a certificate, issued under Section 196.102, Florida Statutes, in which a licensed physician states that an applicant is totally and permanently disabled. It is one of the Alachua County property tax forms that supports a first responder's disability exemption claim before the Alachua County Property Appraiser. On FillingPDF you can fill out the form online and download or print the completed PDF; the form is published by the Alachua County Property Appraiser at acpafl.org.
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What is First Responder’s Physician Certificate of Total and Permanent Disability – Alachua County, FL?
The First Responder’s Physician Certificate of Total and Permanent Disability is the physician's statement, made under Section 196.102, Florida Statutes, that a named applicant is totally and permanently disabled because of an impairment of the mind or body, as part of a first responder's exemption claim.
The certificate has the physician state that the impairment renders the applicant unable to engage in any substantial gainful occupation, and that the condition is reasonably certain to continue throughout the applicant's life. The physician lists the mental or physical condition(s), gives a professional belief within a reasonable degree of medical certainty, and signs and dates the statement. The physician also prints a business address and gives the Florida Board of Medicine or Osteopathic Medicine license number and its issue date.
The physician must be licensed under chapter 458 or chapter 459, Florida Statutes. The form says it is completed by a licensed Florida physician, not by the applicant.
The certificate is only one piece of the claim. The form's notice to the taxpayer explains that a Florida resident applying for an exemption because of a total and permanent disability that occurred in the line of duty as a first responder must present to the county property appraiser the required physician certificate(s), the required documentation from the Social Security Administration, and a certificate from the employer the applicant worked for as a first responder at the time of the injury or injuries, as required by section 196.102(5), Florida Statutes.
Who needs to file First Responder’s Physician Certificate of Total and Permanent Disability – Alachua County, FL?
A licensed Florida physician completes this certificate for a Florida resident who is applying for an exemption because of a total and permanent disability that occurred in the line of duty while serving as a first responder. The applicant then presents it to the county property appraiser.
- Physicians: only a physician licensed pursuant to chapter 458 or chapter 459, Florida Statutes, may complete and sign it. The form says it is to be completed by a licensed Florida physician.
- Applicants: Florida residents claiming the exemption for totally and permanently disabled first responders. The applicant's name and Social Security number go on the form, and disclosure of the number is mandatory under section 196.011(1), Florida Statutes.
The form is not the whole claim. The applicant must also present the required documentation from the Social Security Administration and a certificate from the employer for whom the applicant worked as a first responder at the time of the injury or injuries. The form refers to the required physician certificate(s), so more than one certificate may be required; the Alachua County Property Appraiser can confirm how many.
When to file First Responder’s Physician Certificate of Total and Permanent Disability – Alachua County, FL
The certificate is used when a Florida resident applies for the exemption for a total and permanent disability that occurred in the line of duty as a first responder. The physician completes it before the applicant presents the claim, because the form says the applicant must present the physician certificate(s) to the county property appraiser together with the Social Security Administration documentation and the employer's certificate. No separate due date is printed on the form, and no validity or renewal period is stated on it. For the filing period of the exemption itself, ask the Alachua County Property Appraiser.
Documents you need
- Required documentation from the Social Security Administration: the form's notice says the applicant must present it to the county property appraiser with the physician certificate(s).
- A certificate from the employer for whom the applicant worked as a first responder at the time of the injury or injuries, as required by section 196.102(5), Florida Statutes.
- The required physician certificate(s): this form, completed and signed by a physician licensed under chapter 458 or chapter 459, Florida Statutes, presented to the county property appraiser.
How to fill out First Responder’s Physician Certificate of Total and Permanent Disability – Alachua County, FL
Enter the physician's name
In the opening statement, the physician writes their name on the line labeled Physician’s name. The physician must be licensed under chapter 458 or chapter 459, Florida Statutes.
Select the title and applicant name
Check Mr., Mrs., Miss or Ms. and enter the applicant's name on the line labeled Applicant name.
Enter the Social Security number
Enter the applicant's Social Security number in the three-part field marked with an asterisk. Disclosure is mandatory under section 196.011(1), Florida Statutes.
Describe the condition(s)
Under the statement that the applicant has the following mental or physical condition(s), the physician describes each condition that causes the total and permanent disability.
Confirm the disabled person's name
In the professional-belief paragraph, check the title again and write the name of the totally and permanently disabled person.
Sign and date the certificate
The physician signs on the Signature line and enters the Date. The statement is made to the best of the physician's knowledge and professional belief.
Print the physician's address
Under Address: (print), enter the street, city, state and ZIP.
Add the license number and date
Enter the Florida Board of Medicine or Osteopathic Medicine license number and the date on which it was issued.
Review and download the completed PDF
Check that every line is filled and the names match. Download or print the completed PDF from FillingPDF, then give it to the applicant to present as described under How to submit.
How to submit First Responder’s Physician Certificate of Total and Permanent Disability – Alachua County, FL
The form names one route: the applicant presents it to the county property appraiser. It is not sent anywhere by the physician on its own.
- Presentation to the property appraiser: the notice on the form says each Florida resident applying for the exemption must present the required physician certificate(s), the required Social Security Administration documentation and the employer's certificate to the county property appraiser. For Alachua County, that office is the Alachua County Property Appraiser.
- Address, portal and hours: the form prints none. Contact the Alachua County Property Appraiser, whose website is acpafl.org, for how to deliver the package.
- Social Security number: the number on the form is used to verify taxpayer identity information and homestead exemption information submitted to property appraisers.
Make sure the physician has signed, dated and completed the address and license lines before you deliver it. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Having the applicant complete the certificate instead of a licensed Florida physician; the form says it is to be completed by a licensed Florida physician.
- Using a physician who is not licensed under chapter 458 or chapter 459, Florida Statutes.
- Leaving out the applicant's Social Security number; the form states that disclosure is mandatory under section 196.011(1), Florida Statutes.
- Presenting only the physician certificate, without the Social Security Administration documentation and the employer's certificate the notice requires.
- Skipping the physician's license number and issue date, or the printed street, city, state and ZIP.
- Submitting the form unsigned or undated by the physician.
- Leaving the mental or physical condition(s) blank, or entering a name of the disabled person that differs from the applicant name above.
- Giving false information to claim the exemption; section 196.102(10) makes it a first-degree misdemeanor for taxpayer or physician.
Frequently asked questions
What is the First Responder’s Physician Certificate of Total and Permanent Disability?
It is a certificate, under Section 196.102, Florida Statutes, in which a licensed physician states that an applicant is totally and permanently disabled and unable to engage in any substantial gainful occupation. The applicant presents it to the county property appraiser.
Who has to fill out this physician certificate?
A physician licensed pursuant to chapter 458 or chapter 459, Florida Statutes. The form says it is to be completed by a licensed Florida physician. The applicant does not complete or sign the physician's statement.
Is this one of the Alachua County property tax forms?
Yes. It is published by the Alachua County Property Appraiser as part of the first responder disability exemption, and it is presented to the county property appraiser. It is a physician certificate, not the complete exemption application.
What else do I need besides this certificate?
The form's notice lists the required documentation from the Social Security Administration and a certificate from the employer for whom you worked as a first responder when the injury or injuries occurred, as required by section 196.102(5), Florida Statutes.
Do I have to give my Social Security number on the form?
Yes. The form states that disclosure is mandatory under section 196.011(1), Florida Statutes. It is used to verify taxpayer identity information and homestead exemption information submitted to property appraisers.
What happens if false information is given on the certificate?
Section 196.102(10), Florida Statutes, as printed on the form, says that knowingly and willingly giving false information to claim the exemption is a first-degree misdemeanor, punishable by imprisonment of up to 1 year, a fine, or both. It applies to taxpayer and physician.
Can I fill out the physician certificate online?
You can fill out the PDF online on FillingPDF and download or print it for the physician to sign. FillingPDF is independent, is not affiliated with the property appraiser and does not file the form; you present it to the Alachua County Property Appraiser.
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