The First Responder's Physician Certificate of Total and Permanent Disability is the statement a licensed Florida physician signs under Section 196.102, Florida Statutes, to certify that an applicant is totally and permanently disabled. It is one of the Sarasota County property tax forms published by the Sarasota County Property Appraiser, and it supports an applicant's exemption claim for a disability that occurred in the line of duty as a first responder. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the original PDF lives on the Property Appraiser's website.
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What is First Responder's Physician Certificate of Total and Permanent Disability – Sarasota County, FL?
The First Responder's Physician Certificate of Total and Permanent Disability is a one-page certificate, issued under Section 196.102, Florida Statutes, in which a licensed physician states that a named applicant is totally and permanently disabled and cannot engage in any substantial gainful occupation.
The physician certifies that the applicant is disabled by an impairment of the mind or body, that the impairment makes the person unable to engage in any substantial gainful occupation, and that the condition is reasonably certain to continue throughout his or her life. The certificate then lists the mental or physical condition or conditions and states the physician's professional belief, within a reasonable degree of medical certainty, that those conditions make the person totally and permanently disabled.
The physician must be licensed under chapter 458 or chapter 459, Florida Statutes. The form records the physician's name, signature and date, a printed address (street, city, state, ZIP), and the Florida Board of Medicine or Osteopathic Medicine license number with its issue date.
The form is a piece of a larger application. Its notice explains that a Florida resident applying for an exemption because of a total and permanent disability suffered in the line of duty as a first responder presents this physician certificate (or certificates) to the county property appraiser, together with the required documentation from the Social Security Administration and a certificate from the employer, as section 196.102(5), Florida Statutes, requires. The certificate does not grant an exemption by itself.
Who needs to file First Responder's Physician Certificate of Total and Permanent Disability – Sarasota County, FL?
Florida residents who apply for an exemption because of a total and permanent disability that occurred in the line of duty while serving as a first responder need this certificate. According to the form's notice, they must present the required physician certificate or certificates to the county property appraiser, along with the Social Security Administration documentation and the employer's certificate required by section 196.102(5), Florida Statutes.
The applicant does not complete the medical content. The notice states that the form is to be completed by a licensed Florida physician, and the text says the physician is licensed under chapter 458 or chapter 459, Florida Statutes. The applicant provides identifying information, including a Social Security number that the physician enters on the form.
Both the taxpayer and the physician are warned by the form that knowingly and willingly giving false information to claim the homestead exemption for totally and permanently disabled first responders is a first-degree misdemeanor under section 196.102(10), Florida Statutes. The form does not say that anyone else may sign on the physician's behalf.
When to file First Responder's Physician Certificate of Total and Permanent Disability – Sarasota County, FL
The certificate is needed when you apply for the exemption for totally and permanently disabled first responders, because the form's notice says an applicant must present it to the county property appraiser with the application materials. The form prints no separate due date, so it travels with the exemption application and is obtained from the physician before that application is presented. Ask the Sarasota County Property Appraiser, or the property appraiser of your county, about any application deadline.
Documents you need
- Required documentation from the Social Security Administration, which the form's notice says an applicant presents to the county property appraiser with this certificate.
- A certificate from the employer for whom the applicant worked as a first responder at the time of the injury or injuries, as section 196.102(5), Florida Statutes, requires.
- The physician certificate or certificates themselves: this form, completed and signed by a licensed Florida physician.
How to fill out First Responder's Physician Certificate of Total and Permanent Disability – Sarasota County, FL
Confirm who completes the form
The physician completes this certificate; it must be a physician licensed under chapter 458 or chapter 459, Florida Statutes. The applicant supplies the identifying details.
Enter the physician's name
In the opening statement, enter the physician's name on the line after "I,".
Enter the applicant's name and title
Select Mr., Mrs., Miss or Ms. and enter the applicant's name where the form asks for it.
Enter the Social Security number
Enter the applicant's Social Security number in the three-part field marked with an asterisk. The form states that disclosure is mandatory under section 196.011(1), Florida Statutes.
List the mental or physical conditions
After "has the following mental or physical condition(s):", the physician describes each condition that supports the certification.
Name the disabled person
Select the title again and enter the name of the totally and permanently disabled person on the line provided for it.
Sign and date the certificate
The physician signs and enters the date in the signature block. Do this only after the statements are complete, since the physician affirms they are true, correct and complete.
Print the physician's address
Enter the physician's street, city, state and ZIP in the Address (print) line.
Add license number and issue 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 field is filled and that the name matches on all lines, then download or print the completed PDF from FillingPDF and present it as described under How to submit.
How to submit First Responder's Physician Certificate of Total and Permanent Disability – Sarasota County, FL
The form names one recipient: the county property appraiser. It has no address, portal or fee instructions of its own.
- Present it to the county property appraiser. The notice says each Florida resident applying for the exemption must present the physician certificate(s) to the county property appraiser, together with the required Social Security Administration documentation and the employer's certificate.
- Have the physician complete and sign it first. The form is completed by a licensed Florida physician; the signature, date, address and license number must be on the certificate you present.
For filing details such as location, hours or any online option, contact the Sarasota County Property Appraiser, which publishes this form at the official PDF link on this page. FillingPDF lets you fill out and download the PDF; submission follows the property appraiser's channels.
Common mistakes to avoid
- Having the applicant complete the medical statement; the notice says the form is to be completed by a licensed Florida physician.
- Presenting only the physician certificate, without the Social Security Administration documentation and the employer's certificate that section 196.102(5) requires.
- Leaving the Social Security number blank; the form says disclosure is mandatory under section 196.011(1), Florida Statutes.
- Using a physician who is not licensed under chapter 458 or chapter 459, Florida Statutes.
- Omitting the Florida Board of Medicine or Osteopathic Medicine license number or its issue date.
- Presenting the certificate unsigned or undated.
- Leaving the mental or physical condition(s) section empty, so the certificate does not state what makes the person disabled.
- Giving false information on the form; section 196.102(10) makes knowingly and willingly doing so a first-degree misdemeanor.
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 cannot engage in any substantial gainful occupation. It supports an exemption claim for a first responder disabled in the line of duty.
Who fills out this physician certificate?
A licensed Florida physician. The form's notice says it is to be completed by a licensed Florida physician, and the text specifies a physician licensed under chapter 458 or chapter 459, Florida Statutes. The applicant does not certify the disability.
Do I have to give my Social Security number on this form?
Yes. The form says disclosure of the Social Security number is mandatory under section 196.011(1), Florida Statutes. It will be used to verify taxpayer identity information and the homestead exemption information submitted to property appraisers.
What else must I present with the physician certificate?
The required documentation from the Social Security Administration and a certificate from the employer for whom you worked as a first responder at the time of the injury or injuries. Section 196.102(5), Florida Statutes, requires them along with the physician certificate(s).
Where do I turn in the certificate?
You present it to the county property appraiser. The form gives no address or portal, so contact the Sarasota County Property Appraiser, which publishes the form, or your own county's property appraiser, for location and submission details.
What happens if false information is given on the form?
Section 196.102(10), Florida Statutes, makes it a first-degree misdemeanor for any person to knowingly and willingly give false information to claim this exemption. The form says it is 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. FillingPDF is an independent service, not the property appraiser, and does not submit the certificate; you present it to the county property appraiser yourself.
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