Lost Note Affidavit Form printable pdf download

STATE OF LOUISIANA

PARISH OF NATCHITOCHES

LOST NOTE AFFIDAVIT

BEFORE ME, a Notary Public duly commissioned in and for the above state and parish, personally came

and appeared: __________________________________________, represented herein by

____________________________________________, who declared that:

1. Appearer was the owner and holder of a promissory note executed by

_______________________________________________________________________, payable to the order of

________________________________________, due on demand at ______________________________________,

said note dated _________________________, in the principal sum of ___________ paraphed “Ne Varietur” for

identification with an act of mortgage of even date recorded _______________________, in Mortgage Book

_____________, Page ______________, records of Natchitoches Parish, Louisiana, affecting property located in

Natchitoches Parish, Louisiana.

2. The note has been lost or destroyed and cannot be presented for cancellation of the mortgage.

3. The note has been paid and satisfied in full by the makers.

4. Affiant authorizes the Clerk of Court and ExOfficio Recorder of Mortgages for Natchitoches Parish to

cancel the above described mortgage.

5. Affiant has not sold, transferred, or assigned the note to any other person or entity.

6. Affiant agrees to indemnify any person or entity, including the Clerk of Court and ExOfficio Recorder of

Mortgages, for any damages resulting to such person or entity as a consequence of canceling the mortgage.

7. Affiant makes this affidavit in compliance with Louisiana Revised Statute 9:5168 for purposes of obtaining

cancellation of the aforesaid mortgage without production of the note, and authorizes substitution of this affidavit for

the original note in conjunction with Louisiana Revised Statute 9:5167.

THUS DONE AND SIGNED in ________________, Louisiana, this _________ day of _____________,

200_____.

WITNESSES:

________________________________________

BY: ____________________________

INDIVIDUAL NAME

________________________________________

TITLE: ____________________

______________________________________

NOTARY PUBLIC

Lost Note Affidavit Form