Section 193.503, 196.1961, Florida Statutes
The undersigned hereby requests that the property listed hereon be classified as Historic Property, for property tax
purposes, by the property appraiser of the county in which the property is located based on Ordinance #
adopted by the County.
The undersigned hereby makes application to the property appraiser of the county in which the property listed hereon
is located, for the property tax exemption for Historic Properties based on Ordinance # adopted
by the County.
This form must be signed and returned on or before March 1.
As of January 1, 20 , the property listed above was (check all that apply):
Used for commercial purposes or used by a not-for profit organization under s. 501(c)(3) or (6), I.R.C.
Listed in the National Register of Historic places
A contributing property to a National Register Historic District
Designated as a historic property or as a contributing property to a historic district under the terms of local Ordinance
#
Open to the public no less than 1,800 hours per year
I understand that the property appraiser may require supplemental and additional information, other than the application,
and I am willing to comply with any reasonable request to furnish such information.
Under penalties of perjury, I declare that I have read the foregoing application and that the facts stated in it are true. If prepared
by someone other than the applicant, his/her declaration is based on all information of which he/she has any knowledge.
Record of Action of County Property Appraiser (Check only the appropriate box below.)
Application approved and all property is classified/exempt as Historic Property.
Application disapproved and Historic Property Classification/Exemption denied on all property.
Application approved in part, and disapproved in part - Historic Property Classification/Exemption approved on
the following described portion: Use the space below only if this item is checked. (Field will expand online.)
Signature, property appraiser
APPLICATION AND RETURN FOR CLASSIFICATION/EXEMPTION
OF PROPERTY AS HISTORIC PROPERTY USED FOR
COMMERCIAL OR CERTAIN NONPROFIT PURPOSES
