IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT OF
FLORIDA, IN AND FOR BREVARD COUNTY, FLORIDA
05-_______-_____-__________-XXXX-XX
Division: _________________
____________________________,
Plaintiff
VS.
____________________________,
Defendant(s),
_________________________/
OWNER’S CLAIM FOR
MORTGAGE FORECLOSURE SURPLUS
Under penalty of perjury, I (we) hereby certify that:
1. I was (we were) the owner of the following described real property in Brevard 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 any 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, tax warrant,
condominium lien, cooperative lien, or homeowners’ 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.
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:
____________________________________________.
Law 1338 / Rev. 01-19-2017
1
8. I
(
WE) UNDERSTAND THAT I (WE) AM (ARE) NOT REQUIRED TO HAVE A
LAWYER
OR ANY O
THER 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 I
F ANY S
TATEMENTS ARE UNTRUE THAT I (WE) MAY BE PROSECUTED
CRIMINALLY FOR PERJURY.
____________________________
Print Name: ___________________________
Phone Number: ________________________
___________________________
Print Name: ___________________________
Phone Number: ________________________
STATE OF __________________
COUNTY OF ________________
Sworn to (or affirmed)
and subscribed before me this _____ day of __________,
20___ , by
_____________________________________________________.
(name of person(s)
making
statement)
_______________________________________
(Signature of Notary Public - State
o
f Florida)
(Print, Type, or Stamp Commissioned Name of Notary Public)
Sw orn
and subscribed
to before me this ________ day of ______________________________, 20______, by
__________________________________________________________
Notary Public/Deputy Clerk
Personally Know n ____ OR Produced Identification ____ Type of Identification Produced _________________
Law 1338 / Rev. 01-19-2017
2
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Law 1357 / Eff. 08-03-2016 1
IN THE COURT, EIGHTEENTH JUDICIAL CIRCUIT,
IN AND FOR BREVARD COUNTY, FLORIDA
DIVISION: CASE NUMBER: 05 - - - -XXXX-XX
PLAINTIFF/PETITIONER - (name & address) CLOCK IN
_____________________________________
_____________________________________
_____________________________________
_____________________________________
DEFENDANT/RESPONDENT – (name & address)
_____________________________________
_____________________________________
_____________________________________
_____________________________________
ORDER ON MOTION TO DISBURSE SURPLUS FUNDS
This cause having come before the court on the Motion to Disburse Surplus Funds to
Defendant, it is hereby ordered and adjudged:
1. The Motion to Disburse Surplus Funds to the Defendant is hereby GRANTED/DENIED.
2. The Clerk is hereby directed to disburse the surplus funds in the amount of $_____________,
less any Clerks fees to the defendant,
3. ___________________________________________________________________________
______________________________________________________________________________
DONE AND ORDERED this ______ day of ________________, 20____, in Brevard County,
Florida.
__________________________________
Judge
CIRCUIT
CIVIL
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