Fill and Sign the Request for Cancellation of Claim and Privilege Individual Form

Request for Cancellation of Claim and Privilege Page 1 of 2 REQUEST FOR CANCELLATION OF CLAIM AND PRIVILEGE - INDIVIDUAL (La.Rev.Stats § 9: 48 33) COMES NOW, __________________________________ , as a person who has filed a S tatement of Claim and Privilege on the _____ day of __________________ , 20 ______ and whose address is ________________________________________________________________ , to hereby request that t he recorder of mortgages cancel the Statement of Claim and Privilege from his or her records, and would provide the following: (1) On the _____ day of __________________ , 20 ______ , the undersigned received a written request from ___________________________________ , as Owner or other interested perso n to give this R equest as the Statement of Claim and Privilege ha d either been impr operly filed or the claim or privile ge preserved by the filing of the Statement of Claim and Privilege ha d been extinguished . (2) The undersigned is delivering this Request within ten (10) days of receipt of such written request. This the _____ day of ______________ , 20 _________ . ________________________ Signature _____ ___________________ Type or Print Name Request for Cancellation of Claim and Privilege Page 2 of 2 STATE OF LOUISIANA COUNTY OF ___________________ On this ___ ____ day of ________, 20__, __________ before me personally appeared _______________________________ , to me known to be the person (or persons) described in and who executed the foregoing instrument, and acknowledged that he or she (or they) executed it as his or her (or their) free act and deed. ______________________________ Notary Public ______________________________ Type or Print Name ______________________________ Title (and Rank) (Seal, if any) My appointment expires: ___________________