AFFIDAVIT TO CANCEL BY PRESCRIPTION

STATE OF _____________________

PARISH OF ____________________

BEFORE ME, the undersigned authority, personally came an appeared

_____________________________ who, after being duly sworn, did depose and say that:
There is recorded in the mortgage records of the Parish of Plaquemines the following
encumbrance:
The mortgage of __________________________________________

in favor of ________________________________________ for the sum of

$______________________ ; said mortgage being executed on ______________

______________ and duly recorded in M.O.B. _________, Folio __________ of the records of

the Parish of Plaquemines.

That said mortgage has now prescribed, having never been re-inscribed, and your
deponent being party at interest or an Attorney representing a party at interest, does hereby
authorize and request to Recorder of Mortgages for the Parish of Plaquemines to cancel and
erase from the records of her office the above described encumbrance as recorded in M.O.B.
_________, Folio __________, all accordance with and under the authority contained in various
Louisiana Revised Statues, and also Louisiana Civil Code Articles 3357, 3367 and 3368.
The undersigned acknowledges that he 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.

_____________________________

Print: _______________________

Date: _______________________

SWORN TO AND SUBSCRIBED BEFORE

ME ON _______________________

_____________________________
NOTARY PUBLIC

(Must be accompanied by Mortgage Certificate and Request to Cancel)