Homeowner Declaration Exemption

Homeowner Declaration Exemption
Property Information
Property Address*

Street Address

Street Address Line 2

CityState

Zip Code
Broward County Folio*
Legal Description*
Dwelling Type
Please indicate the exemption you are requesting below, and provide the necessary information required under that exemption.
Select One*
Non-Rental Structure or Unit*

OwnerVacant with no intention of offering for leaseOther
Property Owner Contact Info
Name*

First NameLast Name
Is your mailing address the same as the property address?*

YesNo
Mailing Address Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Best phone number to reach you
E-mail *
example@example.com
This form must be signed as noted below by the property owner and all documentation and notifications as required above must be attached to this form and submitted to this office. Should you require additional information regarding this matter, please contact the Business Tax or Code Compliance Office at (954) 344‐5363.
By typing my name in the below space, I am electronically signing this form. By signing this electronic signature certifies the information to be true, accurate, and complete.*

First NameLast Name
Time & Date Stamp

MonthDayYear
Hour MinutesAM/PM Option
Should be Empty: