The undersigned, ____________________________, hereby certifies that the mortgage, dated ____________, 20__, executed by _______________________ mortgagor, to ______________________________, as mortgagee, and recorded on, 20__, in the office of the ___________________________, in the County of ______________________, State of _________________, in the Book of Mortgages, page ___, together with the debt secured by said mortgage, has been fully paid, satisfied, released, and discharged, and that the property secured thereby has been released from the lien of such mortgage.
IN WITNESS WHEREOF the undersigned has executed this release on the _____ day of ____________, 20__.
STATE OF )
COUNTY OF )
Subscribed and sworn before me this the ____ day of ____________, 20__.
Witness my hand and seal.
_____________________________________ My commission expires: