Dor Form 82163 - Beneficiary'S Declaration Of Additional Funds Received

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FOR RECORDER’S USE ONLY
BENEFICIARY’S DECLARATION OF ADDITIONAL FUNDS RECEIVED
If a beneficiary of a deed of trust receives any private mortgage insurance payments within three months after
the date of a trustee sale foreclosing the deed of trust, the beneficiary must report the amount of the insurance
payment(s) received by completing this declaration and submitting it to the County Recorder in the county where
the property is located within four months after the date of sale pursuant to A.R.S. § 11-1133(B).
1. Assessor’s parcel identification number(s):
3. Date of Trustee’s sale: ________________
Month / Day / Year
Primary parcel: _____ - ____ - _____ - _____
Book
Map
Parcel
Split
Did this transaction include any parcels that are
being split/divided?
4. Highest bid received by Trustee at Trustee’s sale:
Check one:
Yes
No
How many parcels, other than the primary parcel,
$
00
are included in this transaction? ______________
Please list the additional parcels below (attach list if
necessary):
5. Recording number of Trustee’s deed on sale:
(1) ___________________ (2) ________________
______________________________________
(3) ___________________ (4) ________________
2. Name and address of Beneficiary submitting the
6. Private Mortgage Insurance Payment received within
declaration:
three months after the date of the Trustee’s sale:
(Amount received in addition to proceeds of the sale).
__________________________________________
__________________________________________
$
00
__________________________________________
THE FOREGOING INFORMATION IS A TRUE AND CORRECT STATEMENT OF THE FACTS PERTAINING TO THE
TRANSFER OF THE ABOVE DESCRIBED PROPERTY.
Signature of Beneficiary / Agent submitting the Declaration
Print name of Beneficiary / Agent submitting the Declaration
Date __________________________________________
DOR FORM 82163 (09/2013)

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