Affidavit Of Claim (Tax Deed Sale - Excess Proceeds) Form - Florida
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1AFFIDAVIT (TAX DEED SALE – EXCESS PROCEEDS)
Before me this day personally appeared ________________________________________
, who being first duly sworn,
deposes and says:
(Print/Type Name of Affiant)
That, as further stated in Paragraph 3 below, I am one of the person(s) described in F.S. 197.502(4), to wit:
1.
____
1. Legal titleholder of record whose address appears on the record of conveyance of the lands to the owner.
____
2. Lienholder of record whose address appears on the recorded lien That the lien in the amount of
$
___________
(includes applicable interest) has not been transferred or satisfied.
____
3. Mortgagee of record whose address appears on the recorded mortgage.
____
4. Vendee of recorded contract for deed or vendee who has applied to receive notice.
____
5. Other lienholder who has applied to receive notice.
____
6. Person to whom property was assessed on the tax roll for year in which property was last assessed.
____
7. OTHER: If property was acquired by other than a deed (for example, Court Order or Probate), certified copies
of all pertinent documents are attached.
of certain real property legally described as:
2.
That, because of delinquent real property taxes, the above described real property was sold under the
administration of the Clerk of Circuit Court of Martin County, Florida on ______________________ all in
accordance with and pursuant to law.
3.
That at the aforesaid time of sale the above described real property, as connected with Tax Certificate Number
_____________________________, I am one of those persons described in paragraph 1 above and entitled under
F.S. 197.582(2) to certain undistributed surplus funds as my interests appear. My maximum entitlement to such
funds is $____________ , which is subject to all other claims by such other persons as described in F.S.
197.502(4).
4.
Attached, as required, is a copy of my Notice of Surplus, government issued photo ID (for individual claimants)
and any additional supporting documentation.
Signature of Affiant:
______________________________________
Print/Type address and telephone number of Affiant:
______________________________________
(include Email address if applicable)
______________________________________
_________
______
_______________________
State of __________________
County of ________________
Sworn to (or affirmed) and subscribed before me this _____ day of ___________________, 20____, by
______________________________________________, who is personally known to me or who has produced
______________________________________ as identification.
______________________________________
NOTARY SEAL
Printed Name:
_________________________
Notary Public
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