STATE OF LOUISIANA

PARISH OF UNION

AFFIDAVIT OF CANCELLATION BY PRESCRIPTION

BEFORE ME, the undersigned authority, personally came and appeared ___________________________________________________________, who after being by me first sworn on their oath, did depose and say:

That there is of record in Mortgage Book __________, Page __________, a ________________________ mortgage against____________________________________ and in favor of ______________________________________________ dated _______________________________, and recorded on _____________________________.

That said ____________________ mortgage has never been reinscribed or revived in the manner provided by law for preservation, and has therefore prescribed, perempted and become unenforceable.

That appearer is entitled, under the provisions of Act 227 of 1942, to have the inscription of said mortgage cancelled and erased from the records of Union Parish, he being a party at interest, and hereby makes formal written sworn request thereafter.

__________________________________________

SWORN TO AND SUBSCRIBED BEFORE ME, Notary Public for the Parish of Union,

State of Louisiana on this the __________ day of _____________, 20____.

_________________________________________________________

EX-OFFICIAL NOTARY PUBLIC/DEPUTY CLERK OF COURT

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