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K.S.A. 79-3102 (d)(3)
STATE OF )
COUNTY OF )
I, do state that I have personal knowledge of the statements and
(PRINT NAME OF AFFIANT)
representations set forth in this affidavit, and that the consideration stated in the mortgage tendered for filing is verified by this affidavit to be
principal indebtedness covered or included in the previously recorded mortgage(s) listed below with the same lender or their assigns upon which the
registration fee required by KSA 79-3101 et seq. has been previously paid.
LIST MORTGAGES/INSTRUMENTS WHERE FEE PREVIOUSLY PAID:
Lender’s Document Book Page Amt. of Indebtedness
Total Indebtedness Paid On
NEW MORTGAGE/INSTRUMENT TO BE RECORDED:
Lender’s Name New Indebtedness
Additional Indebtedness (New Indebtedness Less Indebtedness Previously Paid On)
SUBSCRIBED AND SWORN TO before me on .
PLEASE ATTACH A COPY OF THE DOCUMENT PAGES THAT ARE REFERENCED FOR MOST TIMELY PROCESSING.
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