The First Responder’s Physician Certificate of Total and Permanent Disability is the form a licensed Florida physician signs to certify that an applicant is totally and permanently disabled, under Section 196.102, Florida Statutes. It is published by the Pinellas County Property Appraiser and is one of the Pinellas County property tax forms used with the homestead exemption for totally and permanently disabled first responders. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the original PDF is published by the Property Appraiser at pcpao.gov.
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What is First Responder’s Physician Certificate – Pinellas County, FL?
The First Responder’s Physician Certificate of Total and Permanent Disability is the form, under Section 196.102, Florida Statutes, on which a licensed Florida physician certifies that an applicant is totally and permanently disabled. The Pinellas County Property Appraiser publishes it.
The certificate records the physician’s statement that the applicant has an impairment of the mind or body that makes him or her unable to engage in any substantial gainful occupation, and that the condition is reasonably certain to continue throughout his or her life. The physician lists the mental or physical condition or conditions and states, within a reasonable degree of medical certainty, that they render the applicant totally and permanently disabled.
The physician must be licensed under chapter 458 or chapter 459, Florida Statutes, and gives a Florida Board of Medicine or Osteopathic Medicine license number, the date it was issued, an address, a signature and a date.
The form is one piece of the exemption file. Under section 196.102(5), Florida Statutes, the applicant also presents 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. This certificate is not an application for the exemption itself.
Who needs to file First Responder’s Physician Certificate – Pinellas County, FL?
A Florida resident who is applying for a homestead exemption because of a total and permanent disability that occurred in the line of duty while serving as a first responder needs this certificate. The form's notice says each such applicant must present the required physician certificate or certificates to the county property appraiser.
The applicant does not complete the medical statement. The form states that it is to be completed by a licensed Florida physician, licensed pursuant to chapter 458 or chapter 459, Florida Statutes.
The certificate alone is not enough. The same notice says 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.
Both the taxpayer and the physician are covered by the form's warning on false information: under section 196.102(10), Florida Statutes, knowingly and willingly giving false information to claim this exemption is a first-degree misdemeanor.
When to file First Responder’s Physician Certificate – Pinellas County, FL
The form sets no deadline of its own. It is presented to the county property appraiser as part of the application for the homestead exemption for totally and permanently disabled first responders, so it is needed whenever that exemption is claimed. The form's notice says the applicant must present the physician certificate or certificates together with the Social Security Administration documentation and the employer's certificate. Have the physician complete and sign the certificate before you assemble that package. For application dates and any renewal rules, contact the Pinellas County Property Appraiser.
Documents you need
- Required documentation from the Social Security Administration, which the applicant presents to the county property appraiser with this certificate, as section 196.102(5), Florida Statutes, requires.
- A certificate from the employer for whom the applicant worked as a first responder at the time of the injury or injuries, presented with the physician certificate or certificates.
- The applicant's Social Security number, entered on the form; the form says disclosure is mandatory under section 196.011(1), Florida Statutes.
How to fill out First Responder’s Physician Certificate – Pinellas County, FL
Enter the physician's name
At the opening statement ("I, ..."), enter the name of the physician. The physician must be licensed pursuant to chapter 458 or chapter 459, Florida Statutes.
Enter the applicant's name and SSN
Enter the applicant's name in the Applicant field and the applicant's Social Security number in the SSN field. Disclosure of the SSN is mandatory under section 196.011(1), Florida Statutes.
List the physical or mental conditions
In the line beginning "has the following mental or physical condition(s):", the physician describes each condition that supports the certification.
Confirm the applicant's name in the belief statement
In the sentence beginning "It is my professional belief...", enter the applicant's name where the form asks who is totally and permanently disabled.
Sign and date the certificate
The physician signs on the Signature line and enters the date. The form states the physician certifies the statements are true, correct and complete to the best of his or her knowledge and professional belief.
Enter address and license details
The physician enters an address, the Florida Board of Medicine or Osteopathic Medicine license number, and the date that license was issued (Issued on).
Review and download the completed PDF
Check that every field is complete and the signature is in place, then download or print the completed PDF from FillingPDF. Assemble the package with the Social Security Administration documentation and employer's certificate, and submit it as described under How to submit.
How to submit First Responder’s Physician Certificate – Pinellas County, FL
The form is presented by the applicant to the county property appraiser. It prints no mailing address, portal or appointment rule of its own, so ask the Pinellas County Property Appraiser, whose website is pcpao.gov, how it accepts the exemption package.
What to present, according to the form's notice:
- the required physician certificate or certificates, signed by the physician;
- the required documentation from the Social Security Administration;
- a certificate from the employer for whom the applicant worked as a first responder at the time of the injury or injuries.
The physician's signature, date, address, license number and issue date must be complete before presenting it. The applicant's Social Security number is required: the form says disclosure is mandatory under section 196.011(1), Florida Statutes, and that it is used to verify taxpayer identity and homestead exemption information submitted to property appraisers. FillingPDF lets you fill out and download the PDF; submission follows the agency's channels.
Common mistakes to avoid
- Having someone other than a licensed Florida physician complete the certificate; the form says it is to be completed by a licensed Florida physician under chapter 458 or chapter 459.
- Presenting the physician certificate alone, without the Social Security Administration documentation and the employer's certificate that the form's notice requires.
- Leaving the applicant's Social Security number blank, although the form states disclosure is mandatory.
- Submitting the certificate without the physician's signature, date, address or license number and issue date.
- Leaving the condition lines empty; the form asks the physician to list the mental or physical condition or conditions.
- Giving false information to claim the exemption; the form warns it is a first-degree misdemeanor under section 196.102(10), Florida Statutes.
Frequently asked questions
What is the First Responder’s Physician Certificate?
It is a form under Section 196.102, Florida Statutes, on which a licensed Florida physician certifies that an applicant is totally and permanently disabled. The Pinellas County Property Appraiser publishes it for the first responder homestead exemption.
Is this one of the Pinellas County property tax forms?
Yes. It is published by the Pinellas County Property Appraiser and supports a homestead exemption claim for totally and permanently disabled first responders. It is a physician's certificate, not the exemption application itself.
Who completes the First Responder’s Physician Certificate?
A licensed Florida physician completes it. The form says it is to be completed by a physician licensed pursuant to chapter 458 or chapter 459, Florida Statutes. The applicant presents the signed certificate to the county property appraiser.
What else do I need besides the physician certificate?
The form's notice says to present the required Social Security Administration documentation and a certificate from the employer for whom you worked as a first responder at the time of the injury or injuries, as section 196.102(5) requires.
Do I have to give my Social Security number on this form?
Yes. The form states that disclosure of your Social Security number is mandatory under section 196.011(1), Florida Statutes. It is used to verify taxpayer identity and homestead exemption information submitted to property appraisers.
What happens if false information is given on the certificate?
Under section 196.102(10), Florida Statutes, a person who knowingly and willingly gives false information to claim this exemption commits a first-degree misdemeanor, punishable by imprisonment of up to 1 year, a fine, or both.
Can I fill out this certificate online on FillingPDF?
You can fill out the PDF online on FillingPDF and download or print it for the physician's signature. FillingPDF is independent, is not the Property Appraiser and does not submit the form; you present it to the county property appraiser.
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