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NOTICE
This return is a public record within the definition of s. 119.011, F.S., and may be inspected by any person
under s. 119.01, F.S. This document does not create any interest enforceable by law in the described
property. This return must be filed in the office of the property appraiser in the county where the property is
located within one year after entering possession, according to s. 95.18, F.S.
Date of filing Date of entering into possession of the property
Name of claimant(s)
Mailing address Legal description of property claimed
Phone
State of Florida
County of
Claimant(s)
being first duly sworn, say(s)
I (We) have read and understand the "notice" at the top of this form and I (We) swear (or affirm) that all representations
made by me (us) on this form are true and correct to the best of my (our) knowledge.
Claimant(s)
State of Florida
County of
Notary signature
RECEIPT
Received in the office of the property appraiser of County, Florida, on .
A signed copy of this return has been delivered to the claimant(s).