CLAIM FORM

Full Name

Phone Number

Property Address

County (if known)

State

Type of Sale

Approximate Year of Sale

Were you the former property owner?

YES NO

Are you the former owner or an heir/legal representative?

Additional Comments or Details

I confirm that the information provided is accurate to the best of my knowledge.

I authorize SIMONIS Surplus Funds Recovery Pro of USA to review public records related to my case.

I understand that SIMONIS is not a law firm and does not provide legal advice.