/ Request for Cancellation of Mortgage Affidavit
in Accordance with La. RS 9:5167(B)

The undersigned Requesting Agency hereby requests Stewart Title Guaranty Company to provide an Affidavit of Lost Paraphed Promissory Note or Release Instrument & Request for Cancellation of Mortgage or Privilege and Release By Licensed Title Insurance Company based on the following information:

1. / All obligations secured by the recorded instrument described below have been satisfied
2. / Stewart Title Guaranty Company Policy has been previously issued (copy attached)
and/or
Agency is requested to issue a Stewart Title Guaranty Company Policy
3. / Policy(ies) referred to in #2 above cover the same property which had secured a debt with the encumbrance being requested to be cancelled.
4. / Requesting Agency has made a due and diligent search for the lost or destroyed paraphed promissory note or release instrument, the note or instrument cannot be located.
5. / 60 days have elapsed since payment or satisfaction of the secured obligation as evidenced by the following attached documents:
a. Written Payoff Statement
b. Copy of Cancelled Check which satisfied obligation in accordance with Written Payoff Statement
or
Documentation of Funds wired to satisfy obligation in accordance with Written Payoff Statement
c. Other documents supporting satisfaction attached hereto
6. / Complete Section C of the Affidavit (next page)
7. / Complete Section D of the Affidavit (next page)
Requesting Agency: / Contact Person:
Email:
By:
Authorized Signatory of Requesting Agency / Printed Name of Authorized Signatory

Forward this Request and the Affidavit to or fax to 1-866-592-5180.

Malcolm will review the request. If approved, Malcolm will have the Affidavit executed by an officer of Stewart Title Guaranty Company who will return the executed Affidavit to your office and your office can then have it recorded. Please provide the physical address of your office:

Street Address:
City/State/Zip:

AFFIDAVIT OF LOST PARAPHED PROMISSORY NOTE OR RELEASE INSTRUMENT and

REQUEST FOR CANCELLATION OF MORTGAGE OR PRIVILEGE AND RELEASE BY LICENSED TITLE INSURANCE COMPANY

[Pursuant to La. R. S. 9:5167(B)]

Parish/County of ______

State of ______

BE IT KNOWN THAT on this ______day of ______, 20______, before me, the undersigned Notary Public, appeared STEWART TITLE GUANTY COMPANY, Affiant, a licensed title insurance company as defined in the Louisiana Insurance Code (this DOES NOT include title agents), herein represented by its undersigned duly authorized officer, which declared that:

A.All obligations secured by the mortgage or vendor’s privilege described below have been satisfied and the above named title insurance company has issued or will issue a policy of title insurance covering the same property which had secured a debt with the below described mortgage or vendor’s privilege.

B.The Affiant has made a due and diligent search for the lost or destroyed paraphed promissory note or release instrument, the note or instrument cannot be located, and 60 days have elapsed since payment or satisfaction of the secured obligation.

C.The description of the lost note or instrument is as follows:

Lost paraphed promissory note:
Dated: / In the Amount of $
Granted by:
In favor of:
Executed before: Notary Public
OR
Lost Release Instrument executed by (copy attached)

D.The Clerk of Court and Ex-Officio Recorder of Mortgages for the Parish identified below is hereby expressly requested, authorized and directed to cancel the recordation of the mortgage or privilege described as follows:

A Mortgage or Privilege:
Granted by:
In favor of :
Date of Instrument: / Parish of Recordation:
Recording Date: / Recorded at
Property Description IS NOT attached, this document is intended as a FULL release of the aforesaid inscription.
Property Description IS attached, this document is intended as a PARTIAL release of aforesaid inscription.

E.The above title insurance company agrees to be personally liable to and indemnify the recorder of mortgages and any person relying upon the cancellation by affidavit for any damages that they may suffer as a consequence of such reliance if this affidavit contains materially false or incorrect statements that cause the recorder to incorrectly cancel the recordation of a mortgage or privilege.

Signature:
Name of Title Insurance Company Officer and Title:
Name of Title Insurance Company and Mailing Address / Stewart Title Guaranty Company
P. O. Box 2029
Houston, TX 77056
______
Notary Public
Printed Name of Notary:
Notary or Bar Number: / Commission Expires: