Tax Deed Sale- Excess Proceeds Affidavit/statement Of Claim Form

Tax Deed #:

__________

Certificate #:

__________ Sale of:

______

TAX DEED SALE- EXCESS PROCEEDS AFFIDAVIT/STATEMENT OF CLAIM

___________________________________________, being the first duly sworn, deposes and says:

(Print/Type Name of Affiant and Title if applicable)

1. That as further stated herein, I am one of the persons described in F.S. 197.502(4), to wit:

_____ a.

Legal titleholder of record at the time of sale who acquired title to property described below by that conveyance

recorded at OR Book ________ Page ________, in the Official Records of Pinellas County, Florida, and I/we have

held the fee simple title to same continuously up to the time of issuance of the tax deed.

_____ b.

Lien holder or Mortgagee of record pursuant to that document(s) recorded at:

OR Book ________ Page ________, OR Book ________ Page ________, in the Official Records of Pinellas County,

Florida. Affiant is a duly authorized officer or representative of lien holder or mortgagee. Affiant further states

that its lien(s) remaining to date against the below-described property total(s) $_______________ and such lien(s)

have not been transferred, assigned or satisfied.

_____ c.

Vendee of a recorded contract (recorded at OR Book ______, Page_______) or vendee who has applied to receive

notice

_____ d.

Other lien holder who has applied to receive notice

_____ e.

Person to whom the property was last assessed on the tax roll for the year in which the property was last assessed

_____ f.

OTHER:______________________________________________________________________________________.

Describe how interest was acquired if by other than the above enumerated means (for example, Court Order,

Probate, assignment), and attach appropriate copies of all pertinent documents.

Of certain real property legally described as:

_______________________________________________________________________

That, because of delinquent real property taxes, the above described real property was sold under the administration of the

Clerk of Circuit Court of Pinellas County, Florida, on

__________ all in accordance with and pursuant to law.

That at the aforesaid time of sale of the above described real property, as connected with Tax Certificate #: *__________

Sale of: *______. I am one of those persons described in paragraph 1 above and entitled under Florida Statutes 197.582 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).

Attached, as required, is a copy of my Notice of Overbid Surplus Monies as well as other documents substantiating my claim

and the amount of such claim, including a ledger or account record verifying the lien amount due as of the date of the tax

deed sale and documentation verifying my authority to make such a claim (if applicable).

I request that payment of any surplus funds due me be made payable to: _________________________ and such payment

be mailed to either the address below or to: ________________________________________________________________.

Or (if applicable):

Any interest in the surplus funds from the above referenced Tax Deed file is hereby DISCLAIMED because

___________________________________________________________________________________________.

Signature of Affiant:

_______________________________________________

Affiant Name and Title:

_______________________________________________

Affiant Address:

________________________________________________

Affiant Telephone: _____________________

Affiant Email:_______________________________

STATE OF ____________

COUNTY OF ____________

The foregoing instrument was acknowledged before me this _______ day of ____________, 20 __________

by ___________________________, who is personally known to me or has produced ____________________________, as

identification and who did/did not take an oath.

_______________________________

Notary Public

My Commission Expires:

Items marked with asterisk (*) are required fields

Rev. 2/15

Tax Deed Sale- Excess Proceeds Affidavit/statement Of Claim Form - Florida Page 2

Related Articles

Related forms

Related Categories