Rev- May 21, 1999 F:\!Department Share\New Website\Approved
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AFFIDAVIT (TAX DEED SALE - EXCESS PROCEEDS) TDA#
, being first duly sworn, deposes and says:
(Print/Type Name of Affiant)
1. That, as further stated in paragraph 3 below, I am one of the person(s) described in F.S. 197.502(4), to wit:
1. Legal titleholder of record whose address appears on the record of conveyance of the lands to the
owner.
2. Lienholder of record whose address appears on the recorded lien. That the lien in the amount
of $
(Includes applicable interest) has not been transferred or satisfied.
3. Mortgagee of record whose address appears on the recorded mortgage.
4. Vendee of a recorded contract or vendee who has applied to receive notice.
5. Other lienholder who has applied to receive notice.
6. Person to whom property was assessed on the tax roll for year in which property was last assessed.
7. OTHER: If property was acquired by other than a deed (for example, Court Order or Probate),
certified copies of all pertinent documents are attached.
of certain real property legally described as:
2. That, because of delinquent real property taxes, the above described real property was sold under the
administration of the Clerk of Circuit Court of Hernando County, Florida, on
all in accordance
with and pursuant to law.
3. That at the aforesaid time of sale of the above described real property, as connected with Tax Certificate No.
, I am one of those persons described in paragraph 1 above and entitled under Florida
Statutes 197.582(2) to certain undistributed surplus funds as my interests appear. My maximum entitlement
to such funds is $
, which is subject to all other claims by such other persons as described
in F.S. 197.502(4) within a two year period.
4. Attached, as required, is a copy of my ANotice of Overbid Surplus Monies.@
Signature of Affiant:
Print/Type address and telephone number of Affiant:
(include Email address)
State of
County of
The foregoing instrument was acknowledged before me this
day of , by
, who is personally known to me or who has produced
as identification and who did / did not take an oath.
Notary Seal Notary Public
