Fill and Sign the Request for Cancellation Louisiana Form

REQUEST FOR CANCELLATION In accordance with the provisions of La. C.C. Article 3366, The Recorder of Mortgages for       Parish, Louisiana is hereby requested and directed to cancel the recordation of the following described privilege: ( ) MORTGAGE granted by       In favor of       In the sum of       Dated       Registry Number       MOB       FOLIO       ( ) JUDGMENT granted by       Against       In the sum of       Dated       Registry Number       MOB       FOLIO       ( ) OTHER             Registry Number       MOB       FOLIO       THIS REQUEST TO CANCEL IS BASED ON THE FOLLOWING: (Please initial the appropriate box) ( ) R.S. 44:106 No Paraphed Obligation – Authentic Act signed by Obligee of Record that acknowledges satisfaction ( ) R.S. 44:107 Paraphed Obligation – Note Attached marked “Paid” or “Cancelled” ( ) R.S. 44:107 Paraphed Obligation – An act of release executed before a notary who certifies in the act that the obligation was presented to him by the holder and owner and that he paraphed it for identification with the act of release ( ) R.S. 44:108 Public Officer – (Sheriff, Marshal or other officer as a consequence of a judicial sale or other decree of action) ( ) R.S. 44:111 Bankruptcy Order of Discharge – Affidavit ( ) CC 3367 Prescribed Mortgage or Privilege – Application ( ) CC 3368 Prescribed Judicial Mortgage – Certificate of Clerk of the Court rendering Judgment – that no suit or motion has been filed for revival or certified copy of final judgment rejecting the demand to revive judgment ( ) R.S. 9:5167E Affidavit of Lost Note – After Receipt of Notary who satisfied note out of proceeds ( ) R.S. 9:5167.1 Affidavit to Cancel by Title Insurance Officer ( )       OTHER             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. This       day of       , 20       . SIGNATURE: PRINTED NAME:       COMPANY NAME:       TITLE:       ADDRESS:             TELEPHONE NO.: