Mortgage Discharge Request Form

Mortgage Discharge Request Form

Use this form to request preparation and registration of a discharge or release of mortgage for the property described below. Complete all relevant fields, attach required supporting documentation, and sign the certification at the end. Submission of this form authorizes the mortgagee or its agent to prepare and register documents necessary to effect the discharge as described herein.

Requestor / Contact Information

Requestor Name:

Individual Corporation Trustee Other:

Mortgage and Property Details

Mortgagee / Lender:

Mortgage Instrument / Book & Page or Instrument Number:

Date of Mortgage:    Original Principal Amount: $

Registered Location / County:    Payoff / Final Payment Date:

Request and Authorization

The Requestor hereby requests that the Mortgagee or its authorized agent prepare and register a discharge or release of the above-described mortgage (the "Discharge") on the basis that all indebtedness secured thereby has been paid in full. The Requestor authorizes the Mortgagee to execute, deliver and register the Discharge and to provide certified originals and copies to the Requestor or the Requestor's designate as indicated below.

The Requestor expressly certifies that, to the best of the Requestor's knowledge, no other liens, charges or encumbrances exist against the property that would prevent registration of the Discharge, except as disclosed in writing below:

Mail original Discharge to Requestor address listed above
Hold Discharge for pickup by Requestor or agent
Prepare and register Discharge at land titles / registry office (Requestor to reimburse registration costs)
Send to third party: Name Address

Supporting Documents

Please attach the following where applicable (indicate below). Failure to provide required documentation may delay preparation or registration of the Discharge.

Government-issued photo identification for signing party
Proof of final payment / payoff statement
Written authorization if signed by agent (power of attorney)
Number of mortgage instruments to discharge:

Fees, Payment and Indemnity

The Requestor acknowledges responsibility for payment of any fees charged for preparation, registration, courier and related expenses. The Requestor authorizes the Mortgagee to invoice the Requestor for such fees or to debit an account on file as directed below.

Cheque Wire Transfer Debit/Credit Card Other:

Indemnity: The Requestor shall indemnify and hold harmless the Mortgagee, its officers, employees and agents from and against any loss, cost, liability or expense (including reasonable legal fees) arising from registration of the Discharge based on the representations in this form, except to the extent caused by the Mortgagee's gross negligence or wilful misconduct.

Certification and Authorization

By signing below, the Requestor certifies and warrants that: (a) the indebtedness secured by the referenced mortgage has been paid in full as of the Payoff / Final Payment Date indicated above; (b) there are no additional amounts owing to the Mortgagee under the mortgage except as disclosed herein; (c) all information provided in this form is true, correct and complete; and (d) the Mortgagee is authorized to prepare, execute and register a Discharge and to deliver the Discharge in accordance with the Delivery / Registration Instructions above.

The Requestor acknowledges that the Mortgagee may require additional documentation or execution of lender-prepared discharge instruments prior to registration, and agrees to promptly provide such documentation if requested. The Requestor further authorizes release of mortgage payoff status and registration information to the Requestor's designated agent for the purposes of completing the Discharge.

Additional Notes

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