Fill and Sign the Place of Record Form

Prepared by and after Recording Return to: Name: Firm/Company: Address: Address 2: City, State, Zip: Phone: Assessor’s Property Tax Parcel/Account Number: ))))))))))-------- Above This Line Reserved For Official Use Only------------- CERTIFICATE OF SATISFACTION Place of Record: __________________ Date of Note/Deed of Trust: __________________ Face Amount Secured/Face Amount of Note: __________________ Deed Book: __________________ Page: __________________ Name(s) of Grantor(s)/Maker(s): __________________ Name(s) of Trustee(s): __________________ Face Amount of Note(s) $: __________________ I/we, holder(s) of the above-mentioned note(s) secured by the above-mentioned deed of trust, do hereby certify that the same has/have been paid in full, and the lien therein created and retained is hereby released. GIVEN UNDER MY/OUR HAND(S) THIS ____ DAY OF __________________, 20____ [NOTE HOLDERS] _________________________________ _________________________________ State of _______________ County/City of __________________ Subscribed, sworn to and acknowledged before me by __________________ this ____ day of __________________, 20___. My Commission Expires: ____________
(this day) I sign, date and seal the above-mentioned certificate of satisfaction. I give you full power, authority and confirmation to execute and perform this my declaration of satisfaction against the said (name) (owner/seller/licensor or both) according to law. This certificate has all the signatures of all parties thereto contained in the certificate. Since my signature is not shown on this certificate, I hereby delegate to you this right and authority. I give full power and authority to my heirs to execute and perform this my declaration of satisfaction against the said (owner/seller/licensor or both) and to all others to whom this my declaration of satisfaction applies; and that all the duties and liabilities of the respective granter(s) shall be performed in their absence. 1. Signature of owner, seller, or licensee on the receipt of a grant of a special tax certificate: 2. Signature of titleholder of a special tax bill: 3. Date and content of the statement of special tax levied on the real property: 4. Name/s of grantor(s), maker(s), trustee and lien holder to be notified if changes in status of the lien holder. [note holder's name and address] (signature of titleholder) [titleholder's address] [letter of assignment] (signature of note holder on receipt of a notice of change in status of the note holder) [note holder's name and address] [letter of assignment] (signature of note taker on receipt of a notice of change in status of the note taker) [note taker's name and address] [letter of assignment] (signature of notice taker on receipt of a notice of change in status of the note taker) [note taker's name and address] [letter of assignment] (signature of note taker on receipt of a notice of change in status of the note taker) [note taker's name and address] [letter of assignment] (signature of note taker on