Fill and Sign the County Recorder of County Kentucky on Date the Following Form

- 1 - -------- Above This Line Reserved For Official Use Only ------------- Prepared by and after Recording Return to: ) ) ) ) ) ) ) ) ) ) Name: Firm/Company: Address: Address 2: City, State, Zip: Phone: Assessor’s Property Tax Parcel/Account Number: PARTIAL RELEASE FROM MORTGAGE KNOW ALL MEN BY THESE PRESENTS that _______________________ , do(es) hereby release from that certain mortgage dated _______________________ , executed by _______________________ , Mortgagor(s), to _______________________ , “Mortgagee”, and recorded in Book __________ , page ___________ , Docum ent/Instrument No. _____________ , in the Office of the County Recorder of _______________ County, Kentucky, on [date] ______________ , the following described real property: {Describe Property or Attach description and State "SEE ATTACHED EXHIBIT" This is a partial release and the above identified mortgage remains in full force and effect as to the remaining property. The Corporation executing this instrument is the present holder of the above described Mortgage. [Complete if applicable: The undersigned is the present holder of the above referenced mortgage, by assignment dated _____________ an d recorded in Book __________ , page _____ ______ , Document/Instrument No. _____________ , in the Office of the aforesaid recorder.] - 2 - IN WITNESS WHEREOF, this instrument was executed by the undersigned on this the ____ day of __________________ , 20 ___ . {Name of Corporation} __________________________________ BY: {Type Name] TITLE: {Title with Corporation} STATE OF _________________ COUNTY OF ___________________ The foregoing instrument was acknowledged before me this ___________________ (date), by ________________________________ (name and title of officer or agent) of ________________________ (name of corporation), a ________________________________ (state or place of incorporation) corporation, on behalf of the corporation. __________________ __________________ Notary Public Printed Name: ________________________ My Commission Expires: ________________________ Serial Number, if any ________________________ Prepared by: __________________________________ Signature: Name: ______________________ Mortgagee Name, Address, phone: Current property Owner(s) Name, Address, phone: