Form Rfc 1 - Request For Cancellation
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1REQUEST
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:
(
)
granted by _______________________________________________________________________________
MORTGAGE
In favor of ___________________________________________________________________________________________
In the sum of ______________________________________
Dated___________________________________________
Registry Number _______________________
MOB __________________
FOLIO ______________________
(
)
in favor of _______________________________________________________________________________
JUDGMENT
Against______________________________________________________________________________________________
In the sum of ______________________________________
Dated __________________________________________
Suit Number _________________________
MOB _________________
FOLIO ______________________
(
)
OTHER - Granted By: ________________________________________________________________________________
In Favor of:__________________________________________________________________________________________
Registry Number _______________________
MOB _________________
FOLIO ______________________
THIS REQUEST
TO CANCEL
IS BASED ON THE FOLLOWING:
(Please initial the appropriatebox)
(
)
R.S. 9:5169 No Paraphed Obligation - Authentic Act signed by Obligee of Record that acknowledges satisfaction
(
)
R.S. 9:5170
Note Attached marked "Paid" or "Cancelled"
Paraphed Obligation -
(
)
R.S. 9:5170
An authentic act of release identifying the obligation, by one who decl
ares he is both
Paraphed Obligation -
owner and holder of the obligation, directing the recorder to cancel the incumbrance in whole or in part and a
declaration by the notary that he paraphed the obligation with the act
(
)
R.S. 9:5171 Public Officer - (Sheriff, Marshal or other officer as a consequence of a judicial sale or
other decree or action)
(
)
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. 9:5167 Affidavit of Lost Note - After Receipt of Notary who satisfied note out of proceeds or by Title Insurance
Officer
(
)
R.S. 9:5167.1 Affidavit to Cancel - Cancellation of mortgage inscription by affidavit; penalties (Exhibits - Payoff
Statement and Cancelled Check)
(
)
__________ OTHER
_________________________________________________________________________________
________________________________________________________________________________________
The undersigned acknowledges that he is liable to and shall indemnify the Recorder of Mortgages 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. 9:5174
This _________ day of __________________________________, 20 ________.
SIGNATURE:
__________________________________________________
PRINTED
NAME: ________________________________________________
COMPANY
NAME: ______________________________________________
TITLE:
_________________________________________________________
ADDRESS:
______________________________________________________
________________________________________________________________
TELEPHONE
NO:________________________________________________
RFC 1
Revised 1/1/11
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