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P.O. Box 217 - 99 Water Street, Markleeville, CA 96120 (530) 694-2286 / Fax (530) 694-2491 Web Page - http://www.alpinecountyca.gov COUNTY OF ALPINE Department of Finance Carol McElroy- CAO/DOF Tina Scherer- Chief Deputy Treasurer-Tax Collector 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: Date of Tax Date Tax Deed I UNDERSTAND THAT THE FINAL DATE TO SUBMIT A CLAIM IS: 1 YEAR FOLLOWING THE DATE OF THE RECORDING OF THE DEED TO THE PURCHASER. CLAIMS NOT POSTMARKERD 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 me before this day of by Name of Claimant (typed or printed) Signature of Claimant Daytime Email address: Signature of Notary Public Mailing Address: (Notary Seal)