Florida dr 416 form 2026

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The document is a Physician's Certification of Total and Permanent Disability, which certifies that an individual is totally and permanently disabled due to specific conditions. It requires the physician's details, the patient's information, and a declaration of the disability. The form must be submitted to the county property appraiser by Florida residents applying for a disability exemption by March 1 each year. It also includes legal notices regarding false information and the mandatory disclosure of social security numbers.

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Click ‘Get Form’ to open the Florida DR 416 form in our editor.
Begin by entering the physician’s name at the top of the form. Ensure that it is clearly printed for verification purposes.
Fill in the name of the totally and permanently disabled person, selecting Mr., Mrs., Miss, or Ms. as appropriate.
Input the Social Security Number of the disabled individual, as this is mandatory for processing.
Indicate the date of disability onset and check any applicable conditions such as quadriplegia or legal blindness.
If applicable, check the box indicating whether a wheelchair is required for mobility.
The physician must sign and date the form, providing their address and license number to complete certification.

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Versions	Form popularity	Fillable & printable
2012	4.8 Satisfied (281 Votes)
2008	4.4 Satisfied (40 Votes)
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dr 416 form

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