CLAIM TO SURPLUS PROCEEDS OF A TAX DEED SALE
Claimant’s Name:
Contact name if claimant is not an individual:
Address* City State Zip Code
Phone Number: Email Address:
Tax Deed Number: Date of Sale (If known):
☐ I am not making a claim and waive any claim I might have to the surplus funds on this tax deed sale.
☐ I am claiming surplus proceeds resulting from the above tax deed sale. I am a
Lienholder
Titleholder
1. LIENHOLDER INFORMATION (Complete if claim is based on a lien against the sold property)
A. Type of Lien: Mortgage Court Judgment Condominium/Home Owner’s Association
Other, Describe in detail:
If your lien is recorded in the Clay County Official Records, list the following, if known:
Recording date ; Instrument # ; Book # Page #
B. Original Amount of Lien $
C. Amount Remaining Due (include interest, if applicable $ )
2. TITLEHOLDER INFORMATION (Complete if claim is based on title held on sold property)
A. Nature of Title: Deed; Court Judgment; Other (describe in detail):
If your title is recorded in the Clay County Official Records, list the following, if known:
Recording date ; Instrument # ; Book # Page #
B. Amount of surplus tax sale proceeds claimed $
C. Do you claim this property was your homestead at the time of the sale? YES NO
3. I request that payment of any surplus funds due to me be made payable to
and such payment be mailed to either the address above or to
4. I hereby swear that all of the above information is true and correct.
Date:
Claimant
STATE OF
COUNTY OF
Sworn to and subscribed before me on this day of , 20 by
.
Date:
NOTARY PUBLIC or DEPUTY CLERK
[Print, Type, or stamp commissioned name of notary]
Personally Known
Produced Identification
Type of Identification Produced
*This is where payment will be mailed
