The undersigned, ____________________________________, of ________________________, hereby certifies that the mortgage, dated _________________, 20____, executed by ____________________________________, as mortgagor, to ____________________________________, as mortgagee, and recorded on _________________, 20____, in the office of the County of ______________________, State of ______________________, in the Book of Mortgages, page ______, together with the debt secured by said mortgage, has been fully paid, satisfied, released, and discharged, and that the property secured thereby has been released from the lien of such mortgage.

the undersigned has executed this release on ________________________, 20____.


[Signature / Typed Name]

STATE OF ________________
COUNTY OF ________________

On ______________________ before me, ___________________________________________, personally appeared ___________________________________________, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

WITNESS my hand and official seal.


Affiant _______ Known_______ Unknown _______

ID Produced _____________________



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