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Fill and Sign the La Rev Stat94833 Rs 94833request to Cancel the Form

Fill and Sign the La Rev Stat94833 Rs 94833request to Cancel the Form

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Request for Re -inscription of Notice of Contract Page 1 of 2 REQUEST FOR REINSCRIPTION OF NOTICE OF CONTRACT -INDIVIDUAL (La.Rev.Stats § 9:4 834) COMES NOW, __________________________________ , as an interested person whose address is ________________________________________________________________ , and hereby requests a reinscription of a Notice of Contract from the recorder of mortgages , and would provide the following: (1) The Notice of Contract was filed on the _____ day of __________________ , 20 ______ , registry number ________________________________ (or other r ecordation information of the instrument) . (2) The name of the obligor of the debt secured by the privilege as it appears in the Notice of Contract is: ________________________________ . (3) This Request is being made within the five (5) year period after the Notice of Contract was filed , and before the effect of the filing of the Notice of Contract has ceased. (4) Upon receipt of this Request, the Notice of Contract should be reinscribed. This the _____ day of ______________ , 20 _________ . ________________________ Signature _____ ___________________ Type or Print Name Request for Re -inscription of Notice of Contract Page 2 of 2 STATE OF LOUISIANA COUNTY OF ___________________ On this ___ ____ day of ________, 20__, __________ before me personally appeared _______________________________ , to me known to be the person (or persons) described in and who executed the foregoing instrument, and acknowledged that he or she (or they) executed it as his or her (or their) free act and deed. ______________________________ Notary Public ______________________________ Type or Print Name ______________________________ Title (and Rank) (Seal, if any) My appointment expires: ___________________

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