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