Fill and Sign the Affidavit Lost Note Form

SWORN AFFIDAVIT STATE OF LOUISIANA PARISH OF _______ BE IT KNOWN that on this _____ day of ___________, 20 ___ , before me, the undersigned Notary Public, in and for said Parish and State, duly commissioned and qualified as such, personally cam and appeared: ______________ , a single person, once married to ______________ , from whom she is now divorced, a resident of _______ Parish, whose current mailing address is ______________ ; who being first duly sworn, did specifically attest to and testify to the truth of all of the following allegations and declarations: Affiant was the last holder of the promissory note which is secured by the mortgage or vendor's lien described in the instrument hereinafter set forth and the description of the promissory note and the property are as follows: Promissory note described in instrument of Mortgage dated the ___ day of _______ 20 ___ , recorded in Book ___ , Folio ___ , under Entry No. _______ of the Mortgage Records of _______ Parish, Louisiana; said promissory note being in the amount of ______________ and ___ /l00 ($ _______ ) Dollars, made and subscribed by ______________ , bearing interest at the rate of _______ ( ___ %) percent per annum from date until paid, and payable on demand. The instrument described above bears on the following described property: Tract l: That certain tract of land together with all improvements thereon erected and thereto belonging and all rights of way, passages, servitudes, appurtenances, advantages and prescriptions thereof appertaining, situated in the _______ Ward of _______ Parish, Louisiana, on the _______ side of _______ and in Section ___ , T ___ , R ___ , being bounded now or formerly as follows: Northwesterly by ______________ , Northeasterly by ______________ , North by ______________ , and Southerly by ______________ , and measuring _______ feet along ______________ and _______ feet along its Northern line and _______ feet along its Southern line, containing approximately _______ acres more or less, and having such shape and other dimensions as shown on a Plat of Survey by ______________ , dated the ___ day of _______ _____ , and being further described as Tract No. ___ on the above-described Plat of Survey. Being the same property acquired by ______________ by Act of Cash Sale recorded in Book ___ , Folio ___ , under Entry No. _______ of the Conveyance Records of _______ Parish, Louisiana. Tract 2: That certain tract of land together with all improvements thereon erected and thereto belonging, and all rights of way, passages, servitudes, appurtenances, advantages and prescriptions thereto appertaining, situated in the ______________ Ward of ______________ Parish, Louisiana, on the ______________ side of ______________ , and in Section ___ , Township ___ , Range ___ , being bounded now or formerly as follows: Northwesterly by ______________ and Tract _____ of the above-described plat of survey and by ______________ , Southerly by ______________ , containing approximately ___ acres, and measuring _______ feet along _______ , _______ feet along ______________ , _______ feet along its Southern line, and _______ feet along its Northern line, and having such shape and other dimensions as shown on Plat of Survey by ______________ , dated the ___ day of _______ _____ . Being the same property acquired by ______________ by Act of Cash Sale recorded in Book ___ , Folio ___ , under Entry No. _______ of the Conveyance Records of _______ Parish, Louisiana. Tract 3: That certain tract of land together with all improvements thereon erected and thereto belonging, and all rights of way, passages, servitudes, appurtenances, advantages and prescriptions thereto appertaining, situated in the ______________ Ward of ______________ Parish, Louisiana, on the ___ side of ______________ and in Section ___ , Township ___ , Range ___ , being bounded now or formerly as follows: Northwesterly by ______________ and Tract ___ of plat of survey dated the ___ day of _______ , _____ , prepared by ______________ , Northeasterly by ______________ and Tract ___ of the above- described plat of survey and Southerly by ______________ , containing _______ acres and measuring _______ feet along _______ , _______ feet along its Southerly line and _______ feet along its Northerly line and having such shape and other dimensions as shown on Plat of Survey by ______________ , dated the ___ day of _______ _____ . Being the same property acquired by ______________ by Act of Cash Sale recorded in Book ___ , Folio ___ , under Entry No. _______ of the Conveyance Records of _______ Parish, Louisiana. Affiant further declares that she is the last holder of the promissory note, that said note has been lost and cannot be presented. The note is paid and affiant authorizes the Clerk of Court and Ex-Officio recorder of mortgages to cancel the mortgage or vendor's lien. The affiant has not sold, transferred, or assigned the note to any other person or entity, and the affiant agrees to indemnify any person or entity for any damages resulting to such person or entity as a consequence of canceling the mortgage or vendor's lien pursuant to this affidavit which complies with Louisiana R.S. 9:5l68. THUS DONE AND PASSED at ______________ , _______ Parish, Louisiana, on the day and date first above written, in the presence of the undersigned competent witnesses, who sign with affiant with me, Notary, after due reading thereof. WITNESSES: __________________________ _______________________________ ______________ __________________________ ____________________________ NOTARY PUBLIC