IN Certificate of Release 1

FOR VALUE RECEIVED, ____________________ as __________________ of _______________________ (herein after referred to as "Agent") as an authorized and duly appointed agent of Stewart Title Guaranty Company, a Texas Corporation and a Title Insurance Company authorized and licensed to transact the business of insuring titles to interests in real property in Indiana under IC 27, does hereby release a Real Estate Mortgage, dated ___________, executed by _______________ as Mortgagor ("Mortgagor") to ______________________ as Mortgagee ("Mortgagee"), and recorded ___________________ as Instrument No. _______________ in the Office of the Recorder of ________________ County, State of Indiana. Said Mortgage had an original principal amount of less than One Million Dollars ($1,000.000.00). Said Mortgage was last assigned to ________________ ("Assignee")in an Assignment of Mortgage executed ______________ by _________________ and recorded ______________________ as Instrument No. _______________ in the Office of the Recorder of __________ County, State of Indiana.

The undersigned hereby represents and certifies that: the execution of this Certificate of Release has been authorized by appropriate action taken in accordance with IC 32-29-6 et seq., the Agent's operating agreement or by-laws, and all other governing law with Agent's undersigned representative having all necessary power and authority to execute this Certificate of Release on behalf of the Mortgagor.

The undersigned further represents and certifies that: the Agent received a written Payoff Statement from Mortgagee, Assignee, or its Mortgage Servicer, ______________ ; the Payoff Statement was used to make payment in full of the unpaid balance of the loan secured by the Real Estate Mortgage; the full payment in accordance with the payoff statement was made to and received by the Mortgagee, Assignee or its Mortgage Servicer as evidenced by Agent's bank check, certified check, escrow account check, trust account check, and/or other documents in Agent's possession that evidences such payment; and Mortgagee, Assignee, or its Mortgage Servicer has not executed and recorded a release of the Real Estate Mortgage within sixty (60) days after full payment was made.

The undersigned further represents and certifies that: sixty (60) days as required by IC 32-8-15.5-9 have elapsed since the date payment in full was sent; Agent sent a written notice to the last known address of the Mortgagee, Assignee or its Mortgage Servicer thirty (30) days prior to execution of this Certificate of Release; said notice indicated Agent's intent to execute and record a Certificate of Release with an attachment of an unexecuted copy of the proposed Certificate of Release; and neither Stewart Title Guaranty Company, its officers nor Agent have received written notification of any reason why the Certificate of Release should not be executed and recorded in accordance with IC 32-8-1.5 et seq.

Dated: _______ day of __________, 2001.

____________________________________ Agent

By: ________________________________________

Printed: _____________________________________

Its: _________________________________________

ACKNOWLEDGMENT

STATE OF)

)

COUNTY OF)

Before me, a Notary Public in and for said County and State, personally appeared __________________________, as foregoing Certificate of Release, and who, having been duly sworn, stated that any representations therein contained are true.

Witness my hand and Notarial Seal this ________ day of _______________, 2001.

My commision expires: ____________________________________________

Signature

___________________________________

Printed, Notary Public

Resident of _______________ County,

State of ________________.

This Instrument prepared by: _______________________________

Return Instrument to: _________________________________________________

No guidelines are available for this form at this time.