Fill and Sign the Louisiana Cancel Form

STATE OF LOUISIANA PARISH OF [_PARISH_] AFFIDAVIT TO CANCEL MORTGAGE BEFORE ME, the undersigned authority, personally came and appeared [_BANK_] , hereafter "Bank", whose Tax Identification Number is [_TIN_] , a banking corporation chartered by the State of Louisiana, having its principal place of business at [_Address_] , Louisiana, represented herein by [_AGENT_] , the [_Office_] of Bank, who after being duly sworn, did depose and say that he is authorized to make this affidavit and is personally familiar with the promissory note hereinbelow described: (1) A certain promissory note dated [_Note_Date_] in the principal amount of [_$Amount_] , with interest at the rate of [_interest%_] per annum from date until paid and providing for [_fee%_] attorneys fees in the event of being placed in the hands of an attorney for collection, payable to the order of [_Payee_] [_Terms_] , which said note was signed by [_Borrowers_] . Said promissory note was paraphed for identification with an act of [_type_] mortgage passed before [_Mortgage_Notary_] , Notary Public, on [_Note_Date_] , recorded at [_Recordation_] of the [_Filing_Parish_] , Louisiana public records affecting the following described property: [_Property_Description_] (2) Bank is the last holder of the aforedescribed mortgage note; (3) The aforedescribed mortgage note has been [_lost_] ; (4) The aforedescribed mortgage note has been [_paid_] ; (5) Bank authorizes the [_Filing_Parish_] [_Clerk_of_Court_and_] Recorder of Mortgages to cancel the aforedescribed mortgage; (6) Bank has not sold, transferred, or assigned the note to any other person or entity; and (7) Bank agrees to indemnify any person or entity for any damages resulting to such person or entity as a consequence of cancelling this mortgage pursuant to this affidavit. [_BANK_] By: ________________________ [_AGENT_] [_Office_] SWORN AND SUBSCRIBED TO BEFORE ME ON [_DATE_] . ___________________________________ [_NOTARY_] , NOTARY PUBLIC - 1 - AFFIDAVIT TO CANCEL MORTGAGE - F1BSEC08: This affidavit is executed in accordance with R.S. 9:5168 and submitted to the Clerk of Court and ex officio Recorder of Mortgages as authority for cancellation of a mortgage or vendor's privilege. The affidavit establishes that the promissory note is paid, forgiven or otherwise satisfied, but is lost or cannot be presented. Where the affidavit complies with R.S. 9:5168, the Clerk and ex officio Recorder of Mortgages may not require a mandamus proceeding. WORD KEY EXPLANATION [_PARISH_] Parish of execution. [_BANK_] Name of last holder of lost note. [_TIN_] Tax Identification Number of last holder. [_Address_] Address of principal place of business of last holder. [_AGENT_] Name of person appearing for last holder. [_Office_] Office held by person appearing for last holder. [_Note_Date_] Date of lost note. [_$Amount_] Principal amount of lost note (with $). [_interest%_] Interest rate on lost note (with %). [_fee%_] Percentage attorney's fee on lost note (with %). [_Payee_] Party to whom note is payable. [_Terms_] Payment terms. [_Borrowers_] Names of makers of lost note. [_type_] Indicate type of mortgage. [_Mortgage_Notary_] Notary before whom mortgage securing lost note was executed. [_Recordation_] Recordation data on mortgage securing lost note. [_Filing_Parish_] Parish in which mortgage is filed. [_Property_Description_] Description of property, with acquisition, mortgaged to secure lost note. [_lost_] Lost or cannot be presented (as appropriate). [_paid_] Paid, forgiven or otherwise satisfied (as appropriate) [_Clerk_of_Court_and_] Delete for Orleans Parish filing. [_DATE_] Date of execution. [_NOTARY_] Notary before whom affidavit is executed. - 2 -