Discharge of Mortgage TO: Name of the Registered Owner(s) of Property (the "Owner") RE: Mortgage given by Name of Mortgage Borrower(s) (Mortgagor(s)) to Name of Mortgage Holder dated Date of Mortgage and registered on Date of Registration/Recordal of Mortgage as Number Registration Number of Mortgage, over the property described as Brief Description of Property (ie. 123 Whiteacre Road, Anyplace, Anywhere) (the "Mortgage") The undersigned hereby acknowledges that the Mortgage has been paid and satisfied in full and hereby releases and discharges any and all right, title, interest claim and demand both at law and in equity that it may have to the Mortgage and the property described therein. This Release shall enure to the benefit of the Owner and his heirs, executors, legal representatives, successors and assigns. Dated Date of Discharge. Name of Mortgage Holder STATE OF STATE COUNTY OF COUNTY On Date of Statement (ie. July 1, 2000) before me, Full Name of Notary Taking Sworn Statement, personally appeared Full Name of Person Signing Discharge, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person executed the instrument. WITNESS my hand and official seal. Signature