RESIDENTIAL RENTAL CERTIFICATE APPLICATION
Revised 02/2023
Residential Rental Certificate Exemption Affidavit
Broward Municipal Services District (BMSD)
PROPERTY INFORMATION
Property Currently Occupied
Yes No
Property ID / Folio Number
E-mail Address for Receiving Notices
Dwelling is a single-family or duplex property that is vacant and not intended to be used for a rental property by owner
Dwelling is owner-occupied. Any owner-occupied dwelling unit is exempt from the certificate of use requirement. However,
the remaining units within the building will require a certificate of use.
Family occupied dwelling or dwelling unit. Property is occupied by one or more members of my family such as a parent,
step- parent, or adult child, is being occupied as a single household unit, and I am receiving no net income and, therefore,
does not require a residential rental certificate of use.
Name of family member(s): _______________________________________________________________________________
Relationship to owner: __________________________________________________________________________________
Contact Number(s): ____________________________________________________________________________________
I, _________________________________, attest that I am the owner (‘Affiant’) of the property located at
_____________________________________, that it meets one of the exemption requirements above, and,
therefore, does not require a rental license. If I decide to rent this property at any time, pursuant to Broward
County Ordinance 2013-28, Section 39-118, I will notify the Urban Planning Division’s Code Compliance Section
and take the necessary steps to obtain a rental license immediately. I acknowledge that this affidavit is a “public
record” and if I make a false entry or representation in this affidavit, then I will commit a violation of Section 39-
118. I have carefully considered the contents of this affidavit before signing. I affirm that the contents are true,
to the best of my knowledge.
_____________________________________ ________________________________
Owner/Agent Signature Date
NOTARY PUBLIC
STATE OF FLORIDA, COUNTY OF BROWARD
The foregoing instrument was acknowledged before me by the Affiant by means of physical presence |
online notarization, this _______day of ________________, 20_______, by _______________________.
Personally Known or Produced Identification. ID Type: _______________________________.
_________________________________________ _________________________________________
Signature of Notary Public – State of Florida Name of Notary Typed, Printed or Stamped
CODE COMPLIANCE SECTION
1 North University Drive, #102 • Plantation, FL 33324 • 954-357-9791 • Broward.org/planning