Certificate Request Form - Jefferson Parish Clerk Of Court
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1Jon A. Gegenheimer
JEFFERSON PARISH CLERK OF COURT
Mortgage & Conveyance/UCC Department
P.O. Box 10 ~ Gretna LA 70054-0010 ~ (504) 364-2954 ~
CERTIFICATE REQUEST FORM
Date: ______________________________, 20______
From: _____________________________________________________________________________________________
Address: __________________________________________________________________________________________
City/State/ZIP Code: _______________________________________________________________________________
Telephone: (______) ________________________________
Docket #: _______________________________ Division: __________
_____________________________________________________________________________
VS.
_____________________________________________________________________________
In connection with my seizure and sale of immovable property, above, please run your office’s
conveyance and mortgage certificates exactly as I have instructed below. I understand that I may prepare these
certificates myself, however, I am requesting you to prepare these for me as I instruct below. I also understand
that the Jefferson Parish Clerk of Court will not verify my title work and does not perform title research on my
behalf.
I certify that I have done the necessary examination of title and other documents to my satisfaction, and
I am solely responsible for the instructions in this request. I acknowledge that the clerk of court’s office will not
substitute, alter, add to, or otherwise change the names which I request or the property description which I
provide.
Certificates will be run exclusively in the name or names hereunder set forth and not in any variations
of said name or names. Where a middle initial has been furnished, identical names with no middle initial or
with a varying middle initial will not be run unless specifically requested below. Where no middle initial has
been furnished, identical names with middle initials will not be run unless specifically requested below.
COB/
FIRST
MIDDLE
LAST
SUFFIX
RUN FROM
RUN TO
MOB
1
2
3
4
5
6
7
8
For additional names, and for property description, see attached exhibit.
_____________________________________________________
Attorney of Record – PRINT
_____________________________________________________
Attorney of Record – SIGNATURE
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