Fill and Sign the Louisiana Rs 497309463 Form

REQUEST FOR CANCELLATION BY LICENSED FINANCIAL INSTITUTION (Pursuant to R.S. 44:109B) STATE OF LOUISIANA PARISH OF       BE IT KNOWN that on this       day of       , 20       , before me the undersigned Notary, duly commissioned and qualified in and for the above named Parish and State, PERSONALLY CAME AND APPEARED:       Represented herein by:       Title:       , its duly authorized representative, who after being duly sworn declared: The above named Financial Institution is (Please initial the appropriate box) ( ) Bank ( ) Credit Union ( ) Lending Agency ( ) Other Person Conducting Such Business Whose licensing or regulatory authority is       (Please initial the appropriate box) ( ) The above named financial institution was the obligee or authorized agent of the obligee of the secured obligation described below when the obligation was extinguished; ( ) The above named financial institution is the obligee or authorized agent of the obligee of the secured obligation described below; The said secured obligation has been paid or otherwise satisfied or extinguished and further the said mortgage or privilege is hereby released. The Recorder of Mortgages in and for the Parish of       is hereby requested, authorized and directed to cancel the recordation of the mortgage or privilege described as follows: Mortgage or Privilege granted by:       In favor of       In the sum of       Dated       Registry Number       MOB       FOLIO       of the official records of       Parish, Louisiana, which affects the following described property:                         The undersigned acknowledges that he is liable to and shall indemnify the Recorder of Mortgage of       Parish and any of its employees or agents relying on this Request for Cancellation for any damages they may suffer as a consequence of such reliance in accordance with provisions of R.S. 44:110. WITNESSES: SIGNATURE: PRINTED NAME:       COMPANY NAME:       TITLE:       ADDRESS:             TELEPHONE NO.:       Sworn to and subscribed before me this       day of       , 20       . __________________________________________ Notary Public Printed Name: ____________________________ ID or Bar Roll Number: ____________________ Commission Expires: _______________________