SURPLUS CLAIM FORMCLAIM TO RECEIVE SURPLUS PROCEEDS OF A TAX DEED SALE
Complete and return to: Clerk of the Circuit Court of Collier County/ ATTN: TAX DEEDS
By mail: 3315 Tamiami Tr. E., Naples, FL 34112
By e-mail: taxdeedshelp@collierclerk.com
Note: The Clerk of the Court must pay all valid liens before distributing surplus
funds to a titleholder.
Claimant’s name: ____________________________________________________________
Contact name, if applicable: ____________________________________________________
Address: ___________________________________________________________________
Telephone Number: _______________Email Address: _______________________________
TDA No. ________________
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 claim surplus proceeds resulting from the above tax deed sale.
I am a (check one) ☐Lienholder; ☐Titleholder.
(1) LIENHOLDER INFORMATION (Complete if claim is based on a lien against the sold
property).
(a) Type of Lien: ☐Mortgage; ☐Court Judgment; ☐Other
Describe in detail:
____________________________________________________________________________
If your lien is recorded in the county’s official records, list the following, if known:
Recording date: ____________ Instrument #___________ Book #________ Page #_______
(b) Original amount of lien: $_____________
(c) Amounts due: $_____________
1. Principal remaining due: $_____________
2. Interest due: $_____________
3. Fees and costs due, including late fees: $_______________ (describe costs in detail, include
additional sheet if needed)_______________________________________________________
____________________________________________________________________________
4. Attorney fees: $__________ (provide amount claimed): $____________
(2) TITLEHOLDER INFORMATION (Complete if claim is based on title formerly held on sold
property.)
(a) Nature of title (check one):☐Deed; ☐Court Judgment; ☐ Other (describe in detail)
(b) If your former title is recorded in the county’s official records, list the following, if known:
Recording date: _____________ Instrument #:____________Book#:__________
Page #_________
(c) Amount of surplus tax deed sale proceeds claimed: $____________
(d) Does the titleholder claim the subject property was homestead property?☐Yes ☐No.
(3) I hereby swear or affirm that all of the above information is true and correct.
Date: _______________________________
Signature: ___________________________
STATE OF __________________________
____________________________COUNTY.
Sworn to or affirmed and signed before me on ______________ by _________________
______________________________
______________________________
NOTARY PUBLIC or DEPUTY CLERK
Print, Type, or Stamp Commissioned Name of Notary
☐Personally known, or ☐Produced identification;
Identification Produced: _________________________
The foregoing instrument was acknowledged before me by __ physical presence or __ online
notarization.
(4) A claim may be:
(a) Mailed using the United States Postal Service. The filing date is the
postmark on the mailed claim;
(b) Delivered using either a commercial delivery service or in person. The
filing date is the day of delivery; or
(c) Sent by fax or e-mail, as authorized by the clerk. The filing date is the
date the clerk receives the fax or e-mail.
(5) Except for claims by a property owner, claims that are not filed on or before close of
business on the 120th day after the date of the mailed notice as required by s. 197.582(2),
are barred. A person, other than the property owner, who fails to file a proper and timely
claim is barred from receiving any disbursement of the surplus funds. The failure of any
person described in s. 197.502(4), other than the property owner, to file a claim for
surplus funds within the 120 days constitutes a waiver of interest in the surplus
funds and all claims thereto are forever barred.