Fill and Sign the Rs 3822421 Authorization to Cancel the Inscription of Form

Request for Cancellation of Statement of Claim and Privilege Page 1 of 2 REQUEST FOR CANCELLATION OF STATEMENT OF CLAIM AND PRIVILEGE - CORPO RATION (La.Rev.Stats § 9:48 33) COMES NOW, __________________________________ , as a representative of _________________________________ a ________________________________ corporation that 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 _____ ___________________________ Title _____ ___________________________ Name of Corporation Attest: Secretary Request for Cancellation of Statement of Claim and Privilege Page 2 of 2 STATE OF LOUISIANA COUNTY OF ___________________ On this ________ day of ________, 20__, before me appeared ______________________________, to me personally known, who, being by me duly sworn (or affirmed) did say that he or she is the president (or other officer or agent of the corporation or association), of ______________________ (describing the corporation o r association), and that the seal affixed to said instrument is the corporate seal of said corporation (or asso ciation) and that the instrument was signed and sealed in behalf of the corporation (or association) by authority of its Board of Directors (or trustees) and that ________________________ acknowledged the instrument to be the free act and deed of the corpo ration (or association) or that the corporation (or asso ciation) has no corporate seal. ______________________________ Notary Public ______________________________ Type or Print Name ______________________________ Title (and Rank) (Seal, if any) My appointment expires: ___________________