PARCEL #: _______________________________________ TAX YEAR ____________
NAME: __________________________________ SITE ADDRESS:_______________________________________
A married couple or family unit is allowed to claim only one homestead exempon or residency based tax exempon (FL
Constuon Are VII Secon 6(b)). Please answer the quesons below and aach documentaon as requested, so that we
may determine your eligibility to qualify for homestead exempon.
1. Have you and your spouse divorced? Yes No If yes, date of divorce___________________
If yes, aach a copy of the Final Judgment if recorded outside Walton County, and skip quesons 2-15. Sign and return.
2. Is a divorce pending? Yes No If yes, aach copies of filed documents.
3. Are you separated from your spouse?
Yes No If yes, since (date) _____________________
4. What is the date of your marriage? _____________ Spouse’s Name _________________________________
5. Spouse’s Address __________________________________________________________________________
6. Spouse’s Phone Number _______________________________
7. Does your spouse claim a homestead or ANY residency based tax exempon in Florida, any other state or
jurisdicon? (Including District of Columbia and Puerto Rico)
Yes No
If you checked NO for queson 7, aach proof that your spouse does not benefit from a residency based tax exempon,
and skip quesons 8 – 15. Sign and return.
If you checked YES for queson 7, answer remaining quesons below in order to determine your eligibility for an
exempon under the Separate Family Units status. Sign and return.
8. Do you spend me in the other’s home or go back and forth between them? Yes No
9. Do you travel, vacaon, or socialize with your spouse?
Yes No
10. Do you and your spouse maintain separate bank or nancial accounts?
Yes No
11. Do you have any bank or nancial accounts (including, but not limited to, credit card, rerement, or
investment accounts) in both names?
Yes No
12. Are you a mortgagor on your spouse’s home, or is your spouse a mortgagor on yours?
Yes No
13. Are you listed as a beneciary on any insurance policy, trusts, wills or nancial account owned by your
spouse or is your spouse listed as a beneciary on any insurance policy, trust, will, or nancial account owned
by you?
Yes No
14. Do you e your IRS return separately from your spouse?
Yes No
Aach a copy of most recent IRS tax return. You may redact income and social security numbers.
15. Do you provide support to OR receive support from your spouse in any form including but not limited to:
insurance coverage or premium payments, mortgage assistance or payment, ulity payments, car payments,
or any other form of nancial payments or assistance? DOES NOT INCLUDE court ordered alimony or child
support.
Yes No
I understand that addi�onal documenta�on may be required. I understand that under sec�on 196.131(2), Florida Statutes, any person who
knowingly gives false informa�on to claim homestead exemp�on is guilty of a first-degree misdemeanor, punishable by imprisonment up to
1 year, a fine up to $5,000 or both. Under penal�es of perjury, I declare that I have read the foregoing addendum and the facts in it are true.
____________________________________ _______________ __________________________________
Signature (Required) Date Dayme Phone
ADDENDUM TO HOMESTEAD EXEMPTION
APPLICATION (SEPARATE FAMILY UNITS)
Gary J. Gregor, CFA, AAS
Walton County
Property Appraiser
PARCEL #: _______________________________________
NAME: __________________________________________
Separate Family Unit Checklist
(Copies of the following must be attached to the application)
_____ Drivers License
_____ Voters Registration
_____ Vehicle Registration
_____ Copies of Bank Statements
_____ Copy of Annual IRS Return
_____ Utility Bills
_____ Cancelled check for:
_____ Real Estate Taxes
_____ Mortgage Payments
_____ Home Owners Insurance Policy
_____ Notarized Separation Papers
Gary J. Gregor, CFA, AAS
Walton County
Property Appraiser
