IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT

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IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT, IN AND FOR MARTIN COUNTY, FLORIDA CASE NO. ____________________ JUDGE: ____________________ ____________________________________ Plaintiff, v. ____________________________________ Defendants, ___________________________________________/ OWNER’S CLAIM FOR MORTGAGE FORECLOSURE SURPLUS State of Florida County of Martin Under penalty of perjury, I (we) hereby certify that: 1. I was (we were) the owner of the following described real property in Martin 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, condominium lien, cooperative lien, or homeowners’ association. 4. I am (we are) not currently in bankruptcy. Page 2. 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: 8. I (WE) UNDERSTAND THAT I (WE) AM (ARE) NOT REQUIRED TO HAVE A LAWYER OR ANY OTHER 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 IF ANY STATEMENTS ARE UNTRUE THAT I (WE) MAY PROSECUTED CRIMINALLY FOR PERJURY. _______________________________________ _______________________________________ (Signatures) Sworn to (or affirmed) and subscribed before me this ______day of ________________, 200___, by (name of person making statement). ______________________________________ (Signature of Notary Public - State of Florida Personally Known _____ OR Produced Identification ______ Type of Identification Produced.

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