REQUEST FOR CANCELLATION
In accordance with the provisions of La. C.C. Article 3366, The Recorder of Mortgages for Terrebonne
Parish, Louisiana is hereby requested and directed to cancel the recordation of the following described
privilege:
(Please INITIAL ONE cancellation request listed below)
(
)
MORTGAGE granted by ________________________________________________________________
in favor of _____________________________________________________________________________
in the sum of $ __________________________
Dated _____________________________________
Entry Number __________________________
MOB
______________ FOLIO ______________
(
)
JUDGMENT in favor of _________________________________________________________________
Against _______________________________________________________________________________
In the sum of $ _________________________
Dated: _____________________________________
Entry Number ___________________________
MOB
_____________ FOLIO _______________
(
)
OTHER ______________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Entry Number ___________________________
MOB
_____________ FOLIO _______________
THIS REQUEST TO CANCEL IS BASED ON THE FOLLOWING:
(Please INITIAL the appropriate selection. Please ONLY select ONE of the following.)
(
)
R.S. 9:5169
No Paraphed Obligation – Authentic Act signed by Obligee of Record that
acknowledges satisfaction. (Formerly R.S. 44:106)
(
)
R.S. 9:5170
Paraphed Obligation – Note attached marked “Paid” or “Cancelled” (Formerly R.S.
44:107)
(
)
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 he paraphed
it for identification with the act of release. (Formerly R.S. 44:107)
(
)
R.S. 9:5171
Public Officer – Sheriff, Marshal or other officer as a consequence of a judicial sale or
other decree of action (Formerly R.S. 44:108)
(
)
R.S. 9:5175
Bankruptcy Order of Discharge – Affidavit (Formerly R.S. 44:111)
(
)
CC 3367
Prescribed Mortgage or Privilege – Application
(
)
CC 3368
Prescribed Judicial Mortgage – Certificate of Clerk of 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. 9:5167E
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
(
)
___________
OTHER
_________________________________________________________
________________________________________________________________________
________________________________________________________________________
The undersigned acknowledges that he/she is liable to and shall indemnify the Recorder of Mortgages of
Terrebonne 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 the provisions of R.S. 9:5174.
This __________________ day of _________________________________, _____________.
SIGNATURE:
___________________________________________
PRINTED NAME:
___________________________________________
TITLE:
___________________________________________
COMPANY NAME:
___________________________________________
ADDRESS:
___________________________________________
___________________________________________
___________________________________________
5/2012