Pre-1875 Federal Land Grant Claim Form printable pdf download

EXHIBIT G(3) – CLAIM FORM – PRE-1875 FEDERAL LAND GRANT NON-SECTION

UNDER 1000 FEET - FLORIDA

Write Any Name and Address Corrections

Owner Address:

Below:

<<Owner Name>>

Name:

<<Owner Address 1>>

<<Owner Address 2>>

<<City, State Zip>>

Address:

Covered Property Information:

<<County, State>>

City:

<<Assessor Map ID>>

<<Assessor Parcel ID>>

State and Zip Code:

<<Assessment Number>>

<<Scaled Frontage>>

Please print (or type) clearly in blue or black ink. If you meet the Settlement’s eligibility requirements and wish to make a claim for a

payment, you must complete this Claim Form and attach copies of the required supporting documentation as explained below. This

Claim Form and any required documentation must be postmarked no later than Month Day, Year.

You must (a) provide all the information called for in Section II, (b) sign the Claim Form, and (c) submit with the completed

Claim Form the documents described in Section III. Failure to answer all the questions and provide the required documents may

result in denial of your claim.

You must file a separate Claim Form for each parcel that you own.

If you are married, your spouse must also sign the Claim Form, even if they do not have an ownership interest in the property.

Only one Claim Form should be submitted for all persons who are or were co-owners of a Covered Property. If you have co-

owners, you should submit the Claim Form on behalf of all co-owners. Consult with your co-owners before submitting a Claim

Form.

All co-owners and their spouses will have to sign a Release (if former owners) or a Release and an Easement (if current owners),

or no check for Benefits will be issued. Benefit checks will be issued in the names of all co-owners.

Your final payment will be based on the number of feet of property you own next to the railroad right of way as well as the

amount of time you owned your property. If you did not own the property for the entire Compensation Period, you are eligible to

receive the amount of benefits stated below multiplied by the fraction of time you owned the Covered Property during the

Compensation Period.

If you inherited the property and you wish to have your relative’s period of ownership included in your award, you must include

the documents listed under “Inherited Property” in Section III below.

Please go to for more details on documentation that can support your claim. If you still have questions, you can

call 1-800-000-000.

I. Settlement Payment. If you qualify you will receive $0.26 per foot (if you owned the property for the entire Compensation

Period). You must provide all the documents listed in Section III below.

Pre-1875 Federal Land Grant Claim Form