The undersigned, ____________________________, hereby certifies that the
mortgage, dated ____________, 20__, executed by _______________________
mortgagor, to ______________________________, as mortgagee, and recorded
on, 20__, in the office of the ___________________________, in the
County of ______________________, State of _________________, in the
Book of Mortgages, page ___, together with the debt secured by said
mortgage, has been fully paid, satisfied, released, and discharged, and
that the property secured thereby has been released from the lien of
IN WITNESS WHEREOF the undersigned has executed this release on the
_____ day of ____________, 20__.
STATE OF )
COUNTY OF )
Subscribed and sworn before me this the ____ day of ____________, 20__.
Witness my hand and seal.
_____________________________________ My commission expires: