R09-128
II
I RESOLUTION NO. 09- I ~e
2 A RESOLUTION OF THE CITY OF BOYNTON BEACH, FLORIDA,
3 RELATING TO THE PROVISION OF FIRE RESCUE SERVICES,
4 FACILITIES, AND PROGRAMS IN THE CITY OF BOYNTON
5 BEACH, FLORIDA; IMPOSING FIRE RESCUE ASSESSMENTS
6 AGAINST ASSESSED PROPERTY LOCATED WITHIN THE CITY,
7 FOR THE FISCAL YEAR BEGINNING OCTOBER 1, 2009;
8 APPROVING THE RATE OF ASSESSMENT; APPROVING THE
9 ASSESSMENT ROLL; CONFIRMING AND CONTINUING A
10 PROCEDURE FOR HARDSHIP WAIVERS OR DEFERRALS OF
11 ALL OR PART OF THE CITY'S FIRE RESCUE SPECIAL
12 ASSESSMENT INCLUDING APPLICATION AND REVIEW BY A
13 COMMITTEE, AND ELIGIBILITY CRITERIA FOR SUCH
14 WAIVERS; PROVIDING FOR CONFLICTS; PROVIDING FOR
IS SEVERABILITY; AND PROVIDING AN EFFECTIVE DATE.
16
17 WHEREAS, the City Commission of Boynton Beach, Florida (the "City
18 Commission"), has enacted Ordinance No. 08-017 (the "Ordinance"), which authorizes the
19 imposition of Fire Rescue Assessments for the rescue services, facilities, and programs
20 against Assessed Property located within the City; and
21 WHEREAS, the imposition of a Fire Rescue Assessment for fire rescue services,
22 facilities, and programs each fiscal year is an equitable and efficient method of allocating
23 and apportioning the fire Rescue Assessed Cost among parcels of Assessed Property; and
24 WHEREAS, the City Commission desires to implement a Fire Rescue
25 Assessment program and impose a Fire Rescue Assessment in the City using the
26 procedures provided by the Ordinance, including the tax bill collection method for the
27 fiscal Year beginning on October 1, 2009; and
28 WHEREAS, the City Commission, on July I, 2008, adopted Resolution
29 No. R08-076 (the "Initial Assessment Resolution"); and
30 WHEREAS, the City Commission, on July 21, 2009, adopted Resolution No. 09-
31 106 (the "Preliminary Assessment Resolution"); and,
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IT
WHEREAS, the Preliminary Assessment Resolution contains and references a
brief and general description of the fire rescue services, facilities, and programs to be
provided to Assessed Property; describes the method of apportioning the Fire Rescue
Assessed Cost to compute the Fire Rescue Assessment for fire rescue services, facilities,
and programs against Assessed Property; estimates rates of assessment; and directs the
updating and preparation of the Assessment Roll and provision of the notice required by
the Ordinance; and
WHEREAS, in order to impose Fire Rescue Assessments for the Fiscal Year
beginning October 1, 2009, the Ordinance requires the City Commission to adopt a Final
Assessment Resolution, which establishes the rates of assessment and approves the
Assessment Roll for the upcoming Fiscal Year, with such amendments as the City
Commission deems appropriate, after hearing comments and objections of all interested
parties; and
WHEREAS, the Assessment Roll has heretofore been made available for
inspection by the public, as required by the Ordinance; and
WHEREAS, notice of a public hearing has been published and mailed, as required
by the terms of the Ordinance, which provides notice to all interested persons of an
opportunity to be heard; an Affidavit of Mailing being attached hereto as Appendix A and
the Proof of Publication being attached hereto as Appendix B;
WHEREAS, the City Commission recognizes that the special assessment may
work a hardship on certain residential property owners in the City, and desires to provide a
means whereby affected property owners may request a total or partial waiver of the
special assessment for hardship; and
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II
WHEREAS, a public hearing was held on September 14,2009, and comments
2 and objections of all interested persons have been heard and considered as required by the
3 terms of the Ordinance.
4 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION
5 OF THE CITY OF BOYNTON BEACH, FLORIDA THAT:
6
7 SECTION 1. AUTHORITY, This resolution is adopted pursuant to Ordinance
8 No. 08-017; Resolution No. R08-076; Resolution No. R09-106; Article VIII, Section 2,
9 Florida Constitution; Sections 166.021 and 166.041, Florida Statutes; and other applicable
10 provisions oflaw.
11
SECTION 2. DEFINITIONS AND INTERPRETATION. This resolution
12 constitutes the Final Assessment Resolution as defined in Ordinance.
13 SECTION 3. IMPOSITION OF FIRE RESCUE ASSESSMENTS.
14
(A) The parcels of Assessed Property described in the Assessment Roll, which
15 is hereby approved, are hereby found to be specially benefited by the provision of the fire
16 rescue services, facilities, and programs described or referenced in the Preliminary
17 Assessment Resolution, in the amount of the Fire Rescue Assessment set forth in the
18 Assessment Roll, a copy of which was present or available for inspection at the above
19 referenced public hearing and is incorporated herein by reference. It is hereby ascertained,
20 determined, and declared that each parcel of Assessed Property within the City will be
21 specially benefited by the City's provision of fire rescue services, facilities, and programs
22 in an amount not less than the Fire Rescue Assessment for such parcel, computed in the
23 manner set forth in the Preliminary Assessment Resolution. Adoption of this Final
24 Assessment Resolution constitutes a legislative determination that all parcels assessed
25 derive a special benefit in a manner consistent with the legislative declarations,
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determinations and findings as set forth in the Ordinance, the Preliminary Assessment
Resolution, and this Final Assessment Resolution from the fire rescue services, facilities,
or programs to be provided and a legislative determination that the Fire Rescue
Assessments are fairly and reasonably apportioned among the properties that receive the
special benefit as set forth in the Preliminary Assessment Resolution.
(B) The method for computing Fire Rescue Assessments described and
referenced in the Preliminary Assessment Resolution is hereby approved. The Parcel
Apportionment methodology described in Appendix F of the Preliminary Assessment
Resolution, and adopted in Section 7 of the Preliminary Assessment Resolution, is hereby
approved.
(C) For the Fiscal Year beginning October 1, 2009, the estimated Fire Rescue
Assessed Cost to be assessed is $3,856,652.00. The Fire Rescue Assessments to be
assessed and apportioned among benefited parcels pursuant to the Cost Apportionment and
Parcel Apportionment to generate the estimated Fire Rescue Assessed Cost for the Fiscal
Year commending October 1,2009, are hereby established as follows;
Property Use Cat~ory
Residential
Non-Residential Property Use Cateeories
Commercial
IndustrialIW arehouse
Institutional
Nursing Home
Rate Per Dwelling lJnit
$68 00
Rate Per Square Foot
$0.16
$0.04
$0.17
$0.17
(D)
The above rates of assessment are hereby approved.
Fire Rescue
Assessments for fire rescue services, facilities, and programs in the amounts set forth in the
Assessment Roll, as herein approved, are hereby levied and imposed on all parcels of
Assessed Property described in such Assessment Roll for the Fiscal Year beginning
October L 2009.
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(E)
As authorized in Section 2.14 of the Ordinance, no Fire Rescue Assessment
shall be imposed upon a parcel of Government Property or upon a parcel of Institutional
Property whose use is wholly exempt from taxation under Florida law.
(F)
Any shortfall in the expected Fire Rescue Assessment proceeds due to any
reduction or exemption from payment of the Fire Rescue Assessments required by law or
authorized by the City Commission shall be supplemented by any legally available funds, or
combination of such funds, and shall not be paid for by proceeds or funds derived from the
Fire Rescue Assessments.
(G)
As authorized In Section 2.13 of the Ordinance, interim Fire Rescue
Assessments are also levied and imposed against all property for which a Building Permit is
issued after adoption of this Final Assessment Resolution based upon the rates of
assessment approved herein.
(H)
Fire Rescue Assessments shall constitute a lien upon the Assessed Property
so assessed equal in rank and dignity with the liens of all state, county, district, or municipal
taxes and other non-ad valorem assessments. Except as otherwise provided by law, such
lien shall be superior in dignity to all other liens, titles and claims, until paid.
(1)
The Assessment Roll, as herein approved, shall be delivered to the Tax
Collector for collection using the tax bill collection method in the manner prescribed by the
Ordinance. The Assessment Roll, as delivered to the Tax Collector, shall be accompanied
by a Certificate to Non-Ad Valorem Assessment Roll in substantially the form attached
hereto as Appendix C.
SECTION 4. CONFIRMATION OF PRELIMINARY ASSESSMENT
RESOLUTION. The Preliminary Assessment Resolution is hereby confirmed.
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SECTION 5. EFFECT OF ADOPTION OF RESOLUTION. The adoption of
this Final Assessment Resolution shall be the final adjudication of the issues presented
(including, but not limited to, the determination of special benefit and fair apportionment to
the Assessed Property, the method of apportionment and assessment, the rate of assessment,
the Assessment Roll and the levy and lien of the Fire Rescue Assessments), unless proper
steps shall be initiated in a court of competent jurisdiction to secure relief within 20 days
from the date of this Final Assessment Resolution.
SECTION 6. HARDSHIP WAIVERS OR DEFERRALS.
(A)
The City Commission of the City of Boynton Beach, Florida hereby
continues its program for qualified individuals who need financial assistance to pay all or
part of the Fire Rescue Assessment levied on their property or who seek deferral of payment
of all or part of the Fire Rescue Assessment on their property.
(B)
The City's program for financial assistance shall be commonly referred to
as H.E.L.P., Hardship Extension Loan Program. The following types of financial assistance
are available, based upon need:
1.
Relief from all payments ofan annual Fire Rescue Assessment.
2.
Relief from a portion of payments of an annual Fire Rescue
Assessment.
3.
Deferral of payments of an annual Fire Rescue Assessment.
4. Deferral of a portion of payments of an annual Fire Rescue
Assessment.
(C)
The following individuals are eligible for financial assistance.
1.
Residential Property Owners who meet 2009 HHS Poverty
Guidelines.
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2. Residential property owners that are exempt from ad valorem
taxation pursuant to the following Florida Statutes are eligible to
apply for a Hardship Waiver or Deferral:
a. Section 196.081, Florida Statutes (totally disabled veterans
and surviving spouses of veterans);
b. Section 196.091, Florida Statutes (disabled veterans confined
to wheelchairs);
c. Section 196.101, Florida Statutes (totally and permanently
disabled persons).
3. Residential Property Owners that qualify for the additional
homestead exemption for persons 65 and over authorized pursuant
to Section 196.075, Florida Statutes are also eligible to apply for the
Hardship Waiver.
4. Residential Property Owners that are qualified under the Florida
Homestead Property Tax Deferral Act, Section 197.242, et aI.,
Florida Statutes.
(D)
Eligible Residential Property Owners may submit an application for a
24 Hardship Waiver or Deferral, on a form prepared by the City, with the Finance Department.
25 The Application shall include the following:
26
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1.
Documentation demonstrating eligibility for the Hardship Waiver or
Deferral through one of the criteria from exemptions listed in
Section C above;
2.
A copy of the Tax Bill for the subject property;
31
3.
Description of the facts and circumstances of the hardship.
32
(E)
All Applications for the Hardship Waiver or Deferral must be received by
33 the City's Finance Department on or before November I of each year in order to be
34 considered for the currently billed assessment. For example, all Hardship Waiver or
35 Deferral Applications for the Fire Rescue Special Assessment for the Fiscal Year
36 commencing October 1, 2009, must be received on or before November 1,2009.
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Once received, all applications shall be reviewed by a Hardship Waiver Review
Committee:
(F)
applicant.
(G)
1.
The Committee shall be comprised of three (3) members:
a. City Manager, or his or her designee;
b. City's Finance Director, or his or her designee; and
c. Member appointed by City Commission.
2. The Committee shall review the facts and circumstances to
determine whether a hardship exists to warrant a partial or total
waiver of the special assessment levied upon the applicant's real
property or a deferral of payment of such.
3. The concurrence of a majority of the members of the Committee
shall be necessary to grant a partial or total, waiver or deferral of
payment of the special assessment.
4. The decision of the Committee is final.
The Committee shall render a written decision and provide such to the
If a partial or total waiver or deferral is granted by the Committee, the
Finance Director shall ensure appropriate documentation is provided to the Tax Collector as
to the revised amount of the assessment as to the applicant.
(H)
(I)
(J)
fiscal year.
(K)
An applicant may apply for a Hardship Waiver as to one property only.
An applicant must apply for the Hardship Waiver on an annual basis.
A deferral may be granted for no longer than the end of the then current
When financial assistance is granted pursuant to the H.E.L.P. program, the
City shall pay on behalf of the individual who has been granted assistance by the
Committee all or part of the Fire Rescue Assessment not paid by the individual. The City
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Commission shall appropriate from general funds a sufficient amount to insure timely
payment of an assessment when assistance is warranted.
SECTION 7. CONFLICTS. All resolutions or parts of resolutions in conflict herewith
are hereby repealed to the extent of such conflict.
SECTION 8. SEVERABILITY. If any clause, section, other part or application of this
resolution is held by any Court of competent jurisdiction to be unconstitutional or invalid, in
part or application, it shall not affect the validity of the remaining portions or applications
of this Resolution.
SECTION 9. EFFECTIVE DATE.
This Resolution shall become effective
immediately upon its passage and adoption.
PASSED AND ADOPTED this 14th day of September, 2009.
(C
"':-.,-
Assessment\2009 Final Assessment Resolution.doc
Page 9 of9
APPENDIX A
AFFIDAVIT OF MAILING
AFFIDAVIT OF MAILING
BEFORE ME, the undersigned authority, personally appeared Kurt Bressner and
Sandi Melgarejo, who, after being duly sworn, depose and say:
1. Kurt Bressner, as City Manager of the City of Boynton Beach, Florida
("City"), pursuant to the authority and direction received from the City Commission,
timely directed the preparation of the Assessment Roll and the preparation, mailing, and
publication of notices in accordance with Sections 2.03, 2.04, and 2.05 of Ordinance
No. 08-071, the Fire Rescue Assessment Ordinance (the "Assessment Ordinance") in
conformance with the Preliminary Rate Resolution adopted by the City Commission on
July 21,2009 (the "Preliminary Rate Resolution") .
2. In accordance with the Assessment Ordinance and Chapter 92-264, Laws
of Florida, as amended by Chapter 2003-348, Laws of Florida (collectively, the "Special
Act"), Mr. Bressner timely provided all necessary information for notification of the Fire
Rescue Assessment to the Property Appraiser of Palm Beach County to be included as
part of the notice of proposed property taxes under section 200.069, Florida Statutes,
the truth-in-millage notification. The information provided to the Property Appraiser to
be included on the truth-in-millage notification included the following: the Fire Rescue
Assessment rate expressed in dollars and cents per billing unit, the associated Fire
Rescue Assessment amount, and the purpose of the Fire Rescue Assessment.
3. Because the assessment was being levied against newly affected property
owners for the first time for Fiscal Year 2009-2010, additional notice by first class mail to
the Owner of each newly affected parcel of Assessed Property was also required by the
Assessment Ordinance and the Special Act.
4. Sandi Melgarejo is Project Coordinator for GSG. GSG has caused the
additional mailed notices required by Section 2.05 of the Assessment Ordinance to be
prepared in conformance with the Preliminary Rate Resolution. An exemplary form of
such notice is attached hereto. GSG has caused such individual notices for each
affected property owner to be prepared and each notice included the following
information: the purpose of the assessment; the total amount proposed to be levied
against each parcel; the unit of measurement to be applied against each parcel to
determine the assessment; the number of such units contained within each parcel; the
total revenue the City expects to collect by the assessment; a statement that failure to
pay the assessment could result in foreclosure proceedings against the property as well
as the initiation of proceedings to compel payment by any means authorized by law,
including the collection of any delinquent amounts on a subsequent years' tax bill,
which, if not paid, would cause a tax certificate to be issued against the property which
may result in a loss of title; a statement that all affected property owners have a right to
appear at the hearing and to file written objections with the local governing board within
20 days of the notice; and the date, time, and place of the hearing.
3. On or before August 24, 2009, GSG caused the mailing of the above-
referenced notices in accordance with Sections 2.05 of the Assessment Ordinance and
the Preliminary Rate Resolution by First Class Mail to each affected owner, at the
addresses then shown on the real property assessment tax roll database maintained by
the Palm Beach County Property Appraiser for the purpose of the collection of ad
valorem taxes.
FURTHER AFFIANTS SAYETH NOT.
~
Kurt Bressner, affiant
,/--)
/~( --~
Sandi ;2garejo, affiant
STATE OF FLORIDA
COUNTY OF PALM BEACH COUNTY
The foregoing Affidavit of Mailing was sworn to and subscribed before me this
~ day of ~li, (,....... 2009 by Kurt Bressner, City Manager, City of Boynton
Beach, Florida. e is personally known to me or has produced as
identification and did take an oath NOTARY PUBLlC.STATE OF FI1RlDA
. ,.,..,,,..... Pamela Welsh
t..1 ~olT\mis.sion #DD754091
.",,,,,.., ExpIres. JAN. 31, 2012
'OND''Printea''l\Iame:7~';'" e.tl4 We-/-$ /,
Notary Public, State of Florida
At Large L
My Commission Expires: 1:..11/.;I01;;l,
Commission No.: J)D ?S~091
STATE OF FLORIDA
COUNTY OF LEON
The foregoing Affidavit of Mailing was sworn to and subscribed before me this
-;l"1~ day of _~a+ ,2009 by Sandi Melgarejo, Proj . vernment
Services Group, I ., a Florida corporation. She i ersonally known to me or has
produced as identification and did take an oat .
-f v,j~ ..~ fi~g ~ ":~
?F"nnted Name: ,J. W. .~S
Notary Public, State of Florid~
At Large /. I
My Commission Expires: 5 I. ::1&>(;)
Commission No.: DD 787S"i7
City of Boynton Beach
Post Office Box 310
Boynton Beach, Florida 33425-0310
CITY OF BOYNTON BEACH, FLORIDA
NOTICE OF HEARING TO IMPOSE AND PROVIDE
FOR COLLECTION OF FIRE RESCUE
NON-AD VALOREM ASSESSMENTS
NOTICE DATE. AUGUST 24, 2009
1950 CONGRESS AVENUE LLC
SEMBLER FAMILY PRTNRSHP #35 C/O
5858 CENTRAL AVE
SAINT PETERSBURG FL 33707 1728
Tax Parcel #: 08434520290030010
Sequence Number: BBF-00009
Legal: BOYNTON TOWN CENTER PCD C3-PAR 1 KIA
FUTURE DEV
. . . . . NOTICE TO PROPERTY OWNER' . . . .
As required by Section 197.3632, Florida Statutes, and City Ordinance No. 2008-017, notice is given by the City of Boynton Beach that an
annual assessment for fire rescue services using the tax bill collection method may be levied on your properly for the fiscal year October 1,
2009 - September 30,2010. The City has levied a fire rescue special assessment since 2001 pursuant to Ordinance No. 01-34, as amended,
which Ordinance sunset on September 30, 2008. The City adopted Ordinance No. 08-017 to provide for reenactment of the fire rescue special
assessment within the City commencing with the 2008-2009 Fiscal Year. The purpose of this assessment is to fund fire rescue services
benefiting improved property located within the City of Boynton Beach. The total annual fire rescue assessment revenue to be collected within
the City of Boynton Beach is estimated to be $3,857,841. The annual fire rescue assessment is based on the classification of each parcel of
property and number of billing units contained therein.
Category
Commercial
Type and Number
of Billing Units
3,368 square feet
Total Assessment:
Fiscal Year 09-10
Assessment
$538.88
$538.88
The maximum annual fire rescue assessment for the above parcel for Fiscal Year 2009-201 0 and future fiscal years is $538.88.
A public hearing will be held at 6:30 p.m. on September 14. 2009. in the City Commission Chambers, City Hall, 100 East Boynton Beach
Boulevard, Boynton Beach, Florida, for the purpose of receiving public comment on the proposed assessments. You and all other affected
property owners have a right to appear at the hearing and to file written objections with the City Commission within 20 days of this notice. If you
decide to appeal any decision made by the City Commission with respect to any matter considered at the hearing, you will need a record of the
proceedings and may need to ensure that a verbatim record is made, including the testimony and evidence upon which the appeal is to be
made. In accordance with the Americans with Disabilities Act, persons needing a speciai accommodation or an interpreter to participate in this
proceeding should contact the City Clerk's office at (561)742-6060, at least three days prior to the date of the hearing.
Unless proper steps are initiated in a court of competent jurisdiction to secure relief within 20 days from the date of City Commission action at
the above hearing (including the method of apportionment, the rate of assessment and the imposition of assessments), such action shall be
the final adjudication of the issues presented.
Copies of the Fire Rescue Assessment Ordinance, the Initial Assessment Resolution and the preliminary assessment roll are available for
inspection at the City Clerk's office in City Hall, located at 100 East Boynton Beach Boulevard, Boynton Beach, Florida.
Pursuant to Chapter 92-264, Laws of Florida, as amended by Chapter 2003-348, Laws of Florida, a special act relating to the County, notice of
the fire rescue assessment imposed by the City shall also be included by the Properly Appraiser as part of the notice of proposed property
taxes under Section 200.069, Florida Statutes, the truth-in-millage notification.
Both the fire rescue non-ad valorem assessment amount shown on this notice and the ad valorem taxes for the above parcel will be collected
on the ad valorem tax bill mailed in November. Failure to pay the assessments will cause a tax certificate to be issued against the properly
which may result in a loss of title.
If there is a mistake on this notice, it will be corrected. If you have any questions regarding your fire rescue service assessment, please
contact the Finance Department at (561)742-6310, Monday through Friday between 9:00 a.m. and 5:00 p.m.
..... THIS IS NOT A BILL.....
APPENDIX B
PROOF OF PUBLICATION
THE PALM BEACH POST
Published Daily and Sunday
West Palm Beach, Palm Beach County, Florida
PROOF OF PUBLICATION
STATE OF FLORIDA
COUNTY OF PALM BEACH
Before the undersigned authority personally appeared Ellen Sanita, who on oath
says that she is Call Center Revenue Manager of The Palm Beach Post, a daily
and Sunday newspaper, published at West Palm Beach in Palm Beach County,
Florida; that the attached copy of advertising for a Notice in the matter of Fire
Rescue Assessment was published in said newspaper in the issues of AUl!Ust 20.
2009. Affiant further says that the said The Post is a newspaper published at
West Palm Beach, in said Palm Beach County, Florida, and that the said
newspaper has heretofore been continuously published in said Palm Beach
County, Florida, daily and Sunday and has been entered as second class mail
matter at the post office in West Palm Beach, in said Palm Beach County,
Florida, for a period of one year next preceding the first publication of the
attached copy of advertisement; and affiant further says that she/he has neither
paid nor promised any person, firm or corporation any discount rebate,
commission or refund for the purpose of securing this advertisement for
publication in the said newspaper. Also published in Martin and St. Lucie
Counties.
eJ
Sworn to and subscribed before 20" day of August, A.D. 2009.
Who is personally known to me.
~
NOTARY PlJBUC-STATE OF FLORIDA
@....... Karen M. McLinton
.'\ Commission # DD832672
~ Expires: NOV,IS,2012
BONDl!I>mRU ATWmC BONllIllGco,lIlC.
. ,.:~:.
,d ,-"~'<"1~'
Dt 161'1!;;14. 'ft,'r~,.j,.1V AllIlust 20. 2009
APPENDIX C
FORM OF CERTIFICATE
TO
NON-AD VALOREM ASSESSMENT ROLL
CERTIFICATE
TO
NON-AD VALOREM ASSESSMENT ROLL
I HEREBY CERTIFY that I am the Mayor of the City of Boynton Beach, or authorized
agent of the City of Boynton Beach, Florida (the "City"); as such, I have satisfied myself that all
property included or includable on the non-ad valorem assessment roll for fire rescue services
(the "Non-Ad Valorem Assessment Roll") for the City is properly assessed so far as I have been
able to ascertain; and that all required extensions on the above-described roll to show the non-ad
valorem assessments attributable to the property listed therein have been made pursuant to law.
I FURTHER CERTIFY that, in accordance with the Uniform Assessment Collection
Act, this certificate and the herein described Non-Ad Valorem Assessment Roll will be delivered
to the Palm Beach County Tax Collector by September 15, 2009.
IN WITNESS WHEREOF, I have subscribed this certificate and directed the same to be
delivered to the Palm Beach County Tax Collector and made part of the above described Non-Ad
Valorem Assessment Roll, this ~ day of SepTemb~ ,2009.
CITY OF BOYNTON BEACH, FLORIDA
BY;
~---
\
[To be delivered to Palm Beach County Tax Collector by September 15]
.
Exhibit B
City of Boynton Beach, Florida
Fire Assessment Application for Determination of Eligibility for H.E.L.P.
FISCAL YEAR 2009-2010
NAME:
(LAST)
(FIRST)
SOCIAL SECURITY NUMBER:
ADDRESS:
TELEPHONE #
(STREET)
(CITY)
(STATE)
(ZIP)
FOR EACH PERSON WHO RESIDES WITH YOU AT THE ABOVE ADDRESS, LIST THEIR NAME, AGE
AND RELATIONSHIP TO YOU BELOW OR ON AN ATTACHED SHEET, IF NEEDED:
(NAME)
(AGE)
(RELATIONSHIP)
(NAME)
(AGE)
(RELATIONSHIP)
I CERTIFY THAT I AM A RESIDENTIAL PROPERTY OWNER AND I MEET ONE (1) OF THE CRITERIA
CHECKED IN THE BOX BELOW FOR WHICH I AM REQUESTING ELIGIBILITY FOR H.E.L.P.
(Provide a copy of your2009 Notice of Ad Valorem Taxes and Non-Ad Valorem Assessments)
(PLEASE CHECK THE APPROPRIATE BOX FOR WHICH YOU ARE REQUESTING ELIGIBILITY FOR H.E.L.P.)
o I am a totally disabled veteran AND I am exempt from ad valorem taxes pursuant to Florida
Statutes Section 196.081.
(Provide copy of disability letter from the government or a physician)
o I am the surviving spouse of a totally disabled veteran AND I am exempt from ad valorem
taxes pursuant to Florida Statutes Section 196.081.
(Provide copy of disability letter from the government or a physician)
o I am a disabled veteran confined to a wheelchair AND I am exempt from ad valorem taxes
pursuant to Florida Statutes Section196.091.
(Provide copy of disability letter from the government or a physician)
o I am permanently and totally disabled AND I am exempt from ad valorem taxes pursuant to
Florida Statutes Section 196.101.
(Provide copy of disability letter from the government or a physician)
o I meet the U.S. Department of Health & Human Services (HHS) Poverty Guidelines listed on
Page 2 of this Application.
(Provide a copy of your last two (2) years (2007 & 2008) Federal Income Tax Forms)
OR IF YOU DID NOT FILE INCOME TAXES FOR THE PAST (2) YEARS
(Provide a copy of your last three (3) months bank statements for all accounts)
NOTE: The City may require additional information to determine eligibility.
(Please complete and sign Page 2 of this Application)
Fire Assessment Application for Determination of Eligibility for H.E.L.P.
Page 2
Please explain the financial hardship that makes it difficult or impossible for you to pay this year's
Fire Assessment Amount as levied on the attached Notice from Palm Beach County.
Under penalty of perjury, I hereby swear or affirm that the information I am submitting is true, complete and
correct in order to determine my eligibility for H.E.L.P.
Applicant's signature
Date
DETERMINING IF YOU MEET HHS POVERTY GUIDELINES
2009 HHS Poverty Guidelines PLEASE NOTE WHAT INCOME TO INCLUDE
Size of Poverty Income used to calculate if you meet poverty
Family Unit Guideline level status includes the following sources:
1 $ 10,830
2 $ 14,570 Wages, unemployment compensation, Social
3 $18,310 Security, Supplemental Social Security
4 $ 22,050 Income, public assistance, veterans'
5 $ 25,790 payments, survivor benefits, pension or
6 $ 29,530 retirement income, interest, dividends, rents,
7 $ 33,270
8 $ 37,010 royalties, income from estates, trust,
For each additional person, add $ 3,740 educational assistance, alimony, child support,
Source: Federal Register, Vol. 74, No. 14, assistance from outside the household, and
January 23,2009, pp. 4199-4201 other miscellaneous sources.
CITY REVIEW PROCESS:
~ Applicant submits application to City of Boynton Beach, Financial Services Department, P.O. Box 310,
Boynton Beach FL 33425-0310 postmarked or delivered no later than November 1. 2009.
~ The Hardship Waiver Review Committee reviews application. The Committee includes the City Manager
or designee, the Finance Director or designee and a third member appointed by the City Commission.
);> The Committee's decision to grant a waiver or deferral must be by a majority vote of the Committee.
~ Once the Committee makes a determination, the applicant will be notified in writing of the Committee's
decision. The decision of the Committee is final.
PLEASE SIGN AND RETURN THIS COMPLETED APPLICATION, ALONG WITH YOUR 2009 TAX
NOTICE FROM PALM BEACH COUNTY AND THE REQUIRED DOCUMENTATION FOR THE BOX
CHECKED ON PAGE 1 OF THIS APPLICATION TO:
City of Boynton Beach
Financial Services Department
P.O. Box 310 -100 East Boynton Beach Blvd.
Boynton Beach, FL 33425-0310
(561) 742-6310