Fill and Sign the Pennsylvania Individual Form

Prepared by and after Recording Return to: ) ) ) ) ) ) ) ) ) ) -------- Above This Line Reserved For Official Use Only-------------Name:       Firm/Company:       Address:       Address 2:       City, State, Zip:       Phone:       Assessor’s Property Tax Parcel/Account Number:       SATISFACTION PIECE FOR MORTGAGE FOR VALUABLE CONSIDERATION OF TEN DOLLARS ($10.00), and other good and valuable consideration, cash in hand paid, the receipt and sufficiency of which is hereby acknowledged, _________________________________________, does hereby certify that a certain Mortgage described below is hereby RELEASED AND SATISFIED IN FULL and the real estate described therein is fully released from said Mortgage: Date of Mortgage: Executed by (Mortgagor(s)): To and in favor of (Mortgagee): Filed of Record: In Book , Page , Document/Inst. No. , in the Office of the Recorder of Deeds of County, Pennsylvania, on (date). Property : As described in the Mortgage. Given: to secure a certain Promissory Note in the amount of $ payable to Mortgagee. Assignment (complete if applicable): The undersigned was assigned the Mortgage by assignment dated and recorded in Book , page Document No. , in the aforesaid recorders Office. The undersigned is the present holder of the above described Mortgage. IN WITNESS WHEREOF, this instrument was executed, signed and delivered by the undersigned on this the ____ day of __________________ , 20 ___ . Satisfaction Piece for Mortgage Page 1 of 2 (1 st Grantor’s Signature)       Print Name STATE OF _____________________ COUNTY OF _____________________ On this, the _________ day of _____________________ , _______ , before me _______________________________________ , the undersigned officer, personally appeared _______________________________________ , known to me (or satisfactorily proven) to be the person whose name _____________________________ subscribed to the within instrument, and acknowledged that _______ (he/she/they) executed the same for the purposes therein contained. In witness whereof, I hereunto set my hand and official seal. ______________________________ Notary Public Printed Name: __________________ My Commission Expires: __________________ CERTIFICATION OF GRANTEE’S ADDRESS: Grantee Name and Address: Grantee Name and Address:                                     I hereby certify under penalty of perjury that the above information is true and accurate. Date:       Signature Rank/Position __________________ Satisfaction Piece for Mortgage Page 2 of 2