Cancellation Of Inscription(S) By Prescription Form

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CANCELLATION OF INSCRIPTION(S) BY PRESCRIPTION
Insofar as the following inscriptions have become unenforceable and have prescribed and
preempted, and the effect thereof has ceased because of the prescribed lapse of time, the undersigned
presents mortgage certificates bearing all of the names concerned and covering the prescriptive period(s)
and hereby authorizes, directs, and requests the Clerk of Court & Ex-Officio Recorder of Mortgages of
Jefferson Parish, State of Louisiana, to cancel said encumbrance in full.
The undersigned acknowledges that he/she is liable to and shall indemnify the Recorder of
Mortgages and any person relying on this request for cancellation for any damages they may suffer as a
consequence of such reliance in accordance with the provisions of La. R. S. 44:110.
[ ] Mortgage
[ ] Judgment
[ ] Lien
[ ] Other ____________________________
Granted by or filed against: __________________________________________________________________;
In favor of: _________________________________________________________________________________;
In the sum of: $__________________________; Dated __________________________________;
Recorded in Mortgage Office Book ________ Folio ________, Instrument number ____________________.
[ ] Mortgage
[ ] Judgment
[ ] Lien
[ ] Other ____________________________
Granted by or filed against: __________________________________________________________________;
In favor of: _________________________________________________________________________________;
In the sum of: $__________________________; Dated __________________________________;
Recorded in Mortgage Office Book ________ Folio ________, Instrument number ____________________.
[ ] Mortgage
[ ] Judgment
[ ] Lien
[ ] Other ____________________________
Granted by or filed against: __________________________________________________________________;
In favor of: _________________________________________________________________________________;
In the sum of: $__________________________; Dated __________________________________;
Recorded in Mortgage Office Book ________ Folio ________, Instrument number ____________________.
[ ] Mortgage
[ ] Judgment
[ ] Lien
[ ] Other ____________________________
Granted by or filed against: __________________________________________________________________;
In favor of: _________________________________________________________________________________;
In the sum of: $__________________________; Dated __________________________________;
Recorded in Mortgage Office Book ________ Folio ________, Instrument number ____________________.
_____________________________
__________________________________
DATE
SIGNATURE
PRINTED name of Above Signed Party: _____________________________________________
Company (if applicable): _____________________________________________
Title (if applicable): _____________________________ (Duly Authorized Agent)
Mailing Address: _____________________________________________
City: ________________________ State: ______ ZIP: _____________
e-Mail Address: _______________________________________________________

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