Nevada Tax Collector Excess-Proceeds-Claim-Form-PDF

Source: https://www.nevadacountyca.gov/DocumentCenter/View/14207/Excess-Proceeds-Claim-Form-PDF

COUNTY OF NEVADA

MICHELLE BODLEY

TREASURER-TAX COLLECTOR PHYSICAL: 950 Maidu Ave, Suite 290, Nevada City, CA 95959 MAILING: PO Box 128, Nevada City, CA 95959 PHONE: (530) 265-1285 | FAX: (530) 265-9857 www.nevadacountyca.gov/348/Treasurer-Tax-Collector

CLAIM FOR EXCESS PROCEEDS

Assessment No: ___________________________ Last Assessee: ________________________________

Property Address: __________________________________________________________________________________

Date of Tax Sale: __________________________ Date Tax Deed Recorded: _______________________

I UNDERSTAND THAT THE FINAL DATE TO SUBMIT A CLAIM IS: AND CLAIMS NOT POSTMARKED ON OR BEFORE THAT DATE WILL NOT BE ACCEPTED.

I claim excess proceeds under Revenue and Taxation Code §4675 based upon my interest in the above-described property as a:

☐Lienholder of Record ☐Owner of Record ☐Qualified Heir(s) of Owner of Record

☐Claimant Filing of Behalf of a Business: ___________________________________________________________

☐Assignee of a Party of Interest: __________________________________________________________________

All necessary documentation proving my right to excess proceeds is enclosed. I affirm under penalty of perjury that the foregoing and all enclosures are true and correct to the best of my knowledge.

Name of Claimant (typed or printed: _______________________________________________________________

Claimant’s Mailing Address: _____________________________________________________________________

SIGN

Social Security/Tax ID #: ___________________________ Signature: _____________________________

Amount of Claim: _______________________________________ Daytime Phone: _______________________

A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.

State of California

County of ___________________________________________

Subscribed and sworn to (or affirmed) before me on this __________ day of ______________________________,

20 ________, by _______________________________, proved to me on the basis of satisfactory evidence to be

the person(s) who appeared before me.

SIGN (Seal) Signature ______________________________________________