I claim the above amount of excess proceeds or the present amount due, whichever is less, under Revenue and
Taxation Code Section 4675 subsection (a) and understand this claim form must be postmarked within one year of the
above date of tax deed.
[ ] I unders
tand that I am claiming these funds personally based on the above document(s) available in your
investigation file, and that it is not necessary for me to employ another person to file a claim on my behalf.
I enclose e
vidence of the present amount still due and payable with interest and costs claimed to the date of the tax
sale including the original amount due and an accounting of all payments made on this lien.
(Check any applicable blocks.)
[ ] Partn
ership or Corporate Tax I.D. number:
[ ] My Dr
iver License number is:
State of License No.
[ ] My Soc
ial Security Number is:
I affir
m under penalty of perjury that the foregoing is true and correct to the best of my knowledge.
.
)
My Telephone number is: (
*My current mailing address is:
My email addr
ess is:
*Please
note: Non U.S. Postal System Box Numbers are not acceptable.
EXCESS PROCEEDS CLAIM FORM
NAME OF PARTY OF INTEREST:
Item No:
Description of Property:
APN:
Assessee:
Property Address:
Date So
ld:
Date of Deed:
Amount of Excess Proceeds:
Final Date to Submit Claim:
Executed this
day of
at
Signature of Claimant Title (if official of partnership or corporation)
