County of San Benito 440 Fifth Street, Room 107 Hollister, CA 95023-3894 Mary Lou Andrade
Tax Collector (831) 636-4034 Treasurer/ Public Administrator (831) 636-4043 Facsimile (831) 636-4383
Treasurer – Tax Collector Public Administrator
CLAIM FOR EXCESS PROCEEDS I hereby certify that I am a party of interest in the following real property: Assessment No. _________________
Last Assessee: ________________________________
Property Situs/Address: _____________________________________________________ Date of Tax Sale: __________________ _
Date Tax Deed Recorded: __________________
I UNDERSTAND THAT THE FINAL DATE TO SUBMIT A CLAIM IS: One Year from the Date of the Tax Deed Recording AND CLAIMS NOT RECEIVED BY THE TAX COLLECTOR 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 Assignee of a Party of Interest
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. ______________________________________ Social Security/Taxpayer Identification Number
Subscribed and affirmed to before me This_______day of_______________, 2_______,by
______________________________________ Name of Claimant (typed or printed)
__________________________________________ Signature of Claimant
Daytime Phone: ________________________ ___________________________________________ Mailing Address:
Signature of Notary Public
____________________________________ ____________________________________
(Notary Seal)
____________________________________ Mail completed forms to the address shown above
