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IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL (Clerk of the Circuit Court & Comptroller, Palm Beach County)

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IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT,
IN AND FOR PALM BEACH COUNTY, FLORIDA
CASE NUMBER:
Plaintiff(s)
-vs-
Defendant(s)
/
OWNER’S CLAIM FOR MORTGAGE FORECLOSURE SURPLUS
STATE OF FLORIDA
COUNTY OF PALM BEACH
Under penalty of perjury, I /we hereby certify that:
1. I was / we were the owner of the following described real property in Palm Beach County,
Florida, prior to the foreclosure sale and as of the date of the filing of the Lis Pendens:
(Legal description of real property):
2. I /we
do not owe
money on any
mortgage
on the property that
was
foreclosed
other
than
the
one that
was
paid
off
by
the foreclosure.
3. I/
we
do not owe
any
money that
is
the subject
of an
unpaid judgment, condominium
lien,
cooperative lien,
or homeowner’s association.
4. I am
/ we
are
not currently
in
bankruptcy.
5. I/we have not sold or assigned my/our right to the mortgage surplus.
R
_____ ____ ____ ___ _____ ____ ____ _
Notary Seal
-----------------------------------------
Case No.
Owner’s Claim for Surplus
6. My / our new address is:
7. If there is more than one owner entitled to the surplus, we have agreed that the
surplus should be paid jointly, or to:
At the following address:
8. I / WE UNDERSTAND THAT I / WE AM / ARE NOT REQUIRED TO HAVE A LAWYER
OR ANY OTHER REPRESENTATION AND I / WE DO NOT HAVE TO ASSIGN MY / OUR
RIGHTS TO ANYONE ELSE IN ORDER TO CLAIM ANY MONEY TO WHICH I / WE MAY
BE ENTITLED.
9. I / WE UNDERSTAND THAT THIS STATEMENT IS GIVEN UNDER OATH, AND IF
ANY STATEMENTS ARE UNTRUE THAT I / WE MAY BE PROSECUTED CRIMINALLY
FOR PERJURY.
(owner’s signature [s])
STATE OF: _________________________
COUNTY OF: _______________________
The foregoing instrument was acknowledged before me by means of
□ physical presence or □ online notarization, this ________________ by
______________________, who is personally known to me or who has
produced _________________________
Notary Public
Name typed, printed or stamped
My Commission Expires:__________
R
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IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL (Clerk of the Circuit Court & Comptroller, Palm Beach County)

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Completed 5 July 2021

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