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Uniform Request and Cancellation Affidavit

To request the Clerk of Court and Ex-Officio Recorder of Mortgages to cancel the subject mortgage, concerned individual must execute this Uniform Cancellation Affidavit.Download

Extracted Text for Proper Search

UNIFORM REQUEST  AND CANCELLATION  AFFIDAVIT 
(FOR  MORTGAGES  AND VENDOR'S  LIENS) 
STATE  OF 
PARISH/COUNTY  OF  _ 
BE  IT KNOWN  THAT 	
before me, the undersigned  Notary Public,  appeared: 	
(Name) 
(Corporate  Title and Name 	
of 	Entity  If Applicable) 	
Its  duly  authorized  agent hereinafter  referred to as  affiant,  who after  first being  sworn  declares  that affiant 
is: 
CHECK  ONE 	
BOX ONLY: 	
[]	 	A notary  public requesting  cancellation  under 	La. 	RS. 	9:5167 	A. 	(1), herein  declaring  that affiant  or 
someone  under his direction  did satisfy  the promissory  note, and that  the affiant  or someone  under his 
direction  (1) received  the note  marked  "Paid 	
in Full" from  the last  holder 	of 	the note,  and that the note 
was  lost or destroyed  while 	in 	the affiant's  custody;  or (2)  has  confirmed  that the last  holder 	of 	the 
paraphed  note received  payment 	in full and  sent  the note  but the  note  was never  received,  and that the 
affiant  has made  a due  and diligent  search for the  note,  the note  cannot  be located,  and sixty  days  have 
elapsed  since payment  or satisfaction  of the  note. 	
[]	 	A duly  authorized  officer 	of 	a Louisiana  licensed title insurer  as defined 	in 	La. 	RS. 	22:46 	of 	the 
Louisiana  Insurance  Code, requesting  cancellation  under 	
La. 	RS. 	9:51678 (1), herein  declaring  that all 
obligations  secured 	by 	the mortgage  or vendor's  privilege have been  satisfied, 	and 	that affiant  has made 
a  due  and diligent  search for the  lost  or destroyed  instrument  which was sufficient  to cause  a 
cancellation  of the  mortgage  or vendor's  privilege,  that the lost  or destroyed  instrument  cannot be 
located,  and that sixty  days  have elapsed  since payment  or satisfaction  of the  secured  obligation. 	
[]	 	An authorized  officer 	of 	a title  insurance  business, the closing  notary public,  or the  attorney  for the 
person  or entity  which  made the payment  requesting  cancellation  under 	La. 	RS. 	9:5167.1, herein 
declaring 	
on 	behalf 	of 	the  mortgagor  or 	an 	owner of the  property  encumbered 	by 	the mortgage  that the 
mortgagee  provided a payoff  statement  with respect  to the  loan  secured 	by 	the mortgage  and that the 
mortgagee  has received  payment 	of 	the loan  secured 	by 	the mortgage 	in accordance  with the payoff 
statement, 	as 	evidenced 	by 	(1)  a bank  check,  certified  check, or escrow  account  check which has been 
negotiated 	by 	or 	on 	behalf 	of 	the  mortgagee,  or (2)  other  documentary  evidence of the  receipt 	of 	payment  by the  mortgagee,  including but not  limited  to verification  that the funds  were wired  to the 
mortgagee,  that more  than sixty  days  have  elapsed  since the date  payment  was received 	by 	the 
mortgagee  and that the mortgagee  has not returned  documentary  authorization for cancellation 	of 	the 
mortgage;  and that the mortgagee  has been  given  at least  fifteen  days notice  in writing  of the  intention  to 
execute  and record 	
an 	affidavit 	in accordance  with this 	La. 	R.S. 	9:5167.1,  with a copy 	of 	the  proposed 
affidavit  attached  to the  written  notice.  Affiant declares  that he has  attached  all evidence  required by 
law. 	
[]	 	An  obligee 	of 	record  requesting  cancellation  under 	La. 	RS. 	9:5168, herein declaring  that affiant  is the 
obligee 	
of 	record  of the  mortgage  or vendor's  privilege securing  a paraphed  promissory  note and that 
the  note  has been  lost or destroyed  and cannot  be presented;  that the note  is paid,  forgiven,  or 
otherwise satisfied;  and that  affiant  has not sold,  transferred,  or assigned  the note  to any  other  person  or 
entity.  If affiant 	
is not  the  Original  Obligee 	of Record,  but 	an 	Obligee 	of Record 	by 	recorded  Assignment 	of the inscription to  be cancelled,  a list 	of recorded  Assignments 	is attached. 	
[]	 	An 	obligee of record  requesting  release under 	La. 	RS. 	9:5169,  declaring  that affiant 	is 	herein 
acknowledging  the satisfactions,  releasing or acknowledging  the extinction  of the  mortgage  or privilege. 
If  affiant 	
is not  the  Original  Obligee 	of 	Record,  but 	an 	Obligee 	of 	Record 	by 	recorded  Assignment 	of the 
inscription  to be  cancelled,  affiant has attached  a list  of recorded  Assignments.  JUDGMENTS OR 
LEGAL  MORTGAGES  MAY NOT BE CANCELLED  USING THIS FORM. 	
[]	 	An affiant  requesting  cancellation  under La 	RS. 	9:5170,  herein declaring  that he 	is attaching  herewith 	
[] the paraphed obligation  marked "PAID" or "CANCELLED";  or 
[] an 	authentic act of release  conforming  to the  requirements  of 	La. 	RS. 	9:5170 (A) (2). 	
[]	 	A duly  authorized  officer of a Licensed  Financial Institution  under 	La. 	RS. 	9:5172, herein declaring  that 
the  institution  was the obligee  or the  authorized  agent of the  obligee  of the  obligation  secured by the 
mortgage  or privilege  when the obligation  was extinguished  and that the secured  obligation  has been 
paid  or otherwise satisfied  or extinguished;  or that  the institution  is the  obligee  or authorized  agent 	
of the 
obligee  of the  secured  obligation  and that  it releases  the mortgage  or privilege  and directs  the recorder 
to  cancel  its recordation.

AFFIANT HEREBY EXPRESSLY  REQUESTS, AUTHORIZES,  AND DIRECTS, 	In accordance  with the provisions 	of the 
applicable  statute indicated  by the  checked  box above,  and 	
in accordance  with the provisions 	of 	La. 	Civil  Code  Art. 3366,  that the 
Clerk 	
of Court  and ex officio  Recorder 	of Mortgages  for the  Parish 	of 	to 	
[  ] 	FULLY  CANCEL  OR 	[  ] 	PARTIALLY CANCEL 	
the following: 
A  mortgage 	
or 	vendor's  privilege: 
Granted/Made  by:  , 
In 	
favor 	of:  _ 	
Instrument dated  Recorded 	in 	Parish; 
Recorded 	
in MOB  FOLIO  , INSTRUMENT 	NO. 	, 	
[LEGAL 	DESCRIPTION  OF PROPERTY:  SEE ATTACHMENT  HERETO MADE A PART  HEREOF] 	
AFFIANT  DECLARES  that he has  attached  property description 	as 	required  by law,  and that  he 	is aware  that 	if no property 
description  is attached,  this Affidavit  will be rejected. 
AFFIANT  FURTHER  DECLARES  that if this  Affidavit 	
is intended  to cancel  related  inscriptions,  such as assignments 	or 	subordinations, 	in a Parish  where the Clerk  allows  such cancellations,  he has  attached  a separate  list 	of related inscriptions. 
AFFIANT  WARRANTS  that affiant  has complied  with 	
all 	requirements 	of applicable  law, including  full 	or 	partial discharge 	of 	
the obligation  where the law  requires. 
AFFIANT  AGREES to be  liable  to and  to indemnify  the Clerk 	
of Court  as ex officio  Recorder 	of Mortgages  and any person 
relying  upon the cancellation  by this  affidavit  for any  claims  or damages  suffered as a consequence 	of such  reliance,  if this  affidavit 
contains  materially  false or incorrect  statements. 
AFFIANT  ACKNOWLEDGES 	
BY 	HIS SIGNATURE 	BELOW 	that the contents 	of this  affidavit  are true  and correct  to the 
best 	of his  knowledge,  information,  and belief,  and further  that he is aware  that knowingly  preparing,  signing, 	or filing a Uniform 
Cancellation  Affidavit containing  materially false 	or 	incorrect statements  shall subject  the affiant  to civil  and criminal  liability under 
Louisiana  law, including  the provisions 	of R.S.  9:5174,  R.S. 14:125,  and R.S.  14:133. 
Affiant's  Signature:  Printed Name:  _ 
Company  Name:  Title: ----;-::---:--:_----,-----;-_:--_-:-;- _ 
(Its  duly  authorized  agent.) 
Mailing  Address:  _ 
City: 	
,State: 	Zip:  _ 
Telephone 	
#: 	Email:  _ 	
Sworn 	to 	and subscribed  before me 	this	__	day 	of 	, 20 	. 	
Notary Public (Seal) 
Printed  Name:  _ 
State 	
ofAppointment:  _ 
Notary  or BarNo.  _ 
Commission  expires:  _ 
REQUEST TO CANCEL 
FILER:  Fill out  below  if filer 	
is NOT  the affiant: 	
In accordance  with the provisions 	of Civil  Code  Article  3366, the undersigned  filer requests  the 
Clerk 	
of 	Court  and ex officio Recorder 	of Mortgages  to file  this  Uniform  Cancellation  Affidavit and hereby  requests  the cancellation 
referenced  therein. 	
Signature 
Printed  Name:  _ 
Company:  _ 
Title: 	
----:::---:-:------0----:----:,--------­	(Its  duly  authorized  agent) 
Mailing  Address: 	__	----,-	_ 
City:  State: ZIP:
 
Email:  _
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