Request For Cancellation Form
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1To: Hon. Mike Spence
Caddo Parish Clerk of Court
and ex-officio Recorder of Mortgages
REQUEST FOR CANCELLATION
Pursuant to La. C.C. Article 3366, the Recorder of Mortgages for Caddo Parish, Louisiana is hereby requested and directed to cancel
the recordation of the following described privilege:
( )
MORTGAGE granted by_____________________________________________________________________________
In favor of _________________________________________________________________________________________
In the sum of ____________________________________________
Dated__________________________________
Registry Number _____________________
MOB________________________________
Page _____________
( )
JUDGMENT in favor of _____________________________________________________________________________
Against ___________________________________________________________________________________________
In the sum of ____________________________________________
Dated__________________________________
Registry Number _____________________
MOB ________________________________
Page _____________
( )
OTHER___________________________________________________________________________________________
__________________________________________________________________________________________________
Registry Number _____________________
MOB ________________________________
Page _____________
THIS REQUEST TO CANCEL IS BASED ON THE FOLLOWING
:
(Please initial 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. 9:5170
Paraphed Obligation – An Act of release executed before a notary who certifies in the act that the
obligation was presented to him by the holder and owner and that (s)he paraphed it for identification with
the act of release
( )
R.S. 9:5171
Public Officer (Sheriff, Marshal or other officer as a consequence of a judicial sale or other decree or
action)
( )
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 for revival
( )
R.S. 9:5167E
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
Affidavit of Lost or Destroyed Note
( )
OTHER ______________________________________________________________
_____________________________________________________________________
The undersigned acknowledges that (s)he is liable to and shall indemnify the Recorder of Mortgages of Caddo Parish and his
employees or agents relying on this Request for Cancellation for any damages suffered as a consequence of such reliance pursuant to
R.S. 9:5174.
This _________ day of _______________________, 20______.
SIGNATURE:_________________________________
PRINTED NAME: _____________________________
COMPANY NAME:____________________________
TITLE:_______________________________________
ADDRESS:____________________________________
______________________________________________
TELEPHONE NO.:_____________________________
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