Request For Cancellation Form
ADVERTISEMENT
1REQUEST FOR CANCELLATION
In accordance with the provisions of La. C.C. Article 3366, The Recorder of Mortgages for Lafayette Parish, Louisiana is hereby
requested and directed to cancel the recordation of the following described privilege:
(
)
MORTGAGE made by _____________________________________________________________________________
In favor of _______________________________________________________________________________________
In the sum of ______________________________________
Dated_______________________________________
Registry Number _______________________
(
)
JUDGMENT in favor of ____________________________________________________________________________
Against __________________________________________________________________________________________
In the sum of ______________________________________
Dated _______________________________________
Registry Number _______________________
(
)
OTHER __________________________________________________________________________________________
Against ___________________________________________________________________________________________
In favor of _________________________________________________________________________________________
Registry Number _______________________
THIS REQUEST TO CANCEL IS BASED ON THE FOLLOWING:
(Please check the appropriate box)
(
)
R.S. 9:5169 No Paraphed Obligation – Authentic Act signed by Obligee of Record that acknowledges satisfaction
(
)
R.S. 9:5170 Paraphed Obligation – Note Attached marked “Paid” or Cancelled”
(
)
R.S. 9:5171 Public Officer (Sheriff, Marshal or other officer as a consequence of a judicial sale or other decree of action)
(
)
R.S. 9:5172 Release by Licensed Financial Institution
(
)
R.S. 9:5175 Bankruptcy Order of Discharge – Affidavit
(
)
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. 9:5167A Affidavit of Lost Note After Receipt of Notary who satisfied note out of proceeds
(
)
R.S. 9:5167.1 Affidavit to Cancel by Title Insurance Officer
(
)
R.S. 9:5168 Cancellation by Affidavit – Lost Note Affidavit
(
)
OTHER ______________________________________________________________________________
The undersigned acknowledges that he is liable to and shall indemnify the Recorder of Mortgages of
Lafayette 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: ____________________________________________
Revised 7-26-2012
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business