[Name of affiant] personally appeared before me in ___________ County, State of _________________, and having been duly sworn (or affirmed) made the following affidavit:
1. The affiant is the owner of the note or other indebtedness secured by the deed of trust, mortgage, or other instrument executed by __________________ (grantor, mortgagor), ___________________ (trustee), and __________________ (beneficiary, mortgagee), and recorded in _________________ County at _______________
(book, page); and
2. The note or other indebtedness has been lost and after the exercise of due diligence cannot be located.
3. The affiant certifies that all indebtedness secured by the deed of trust, mortgage, or other instrument was satisfied on ___________________, 20 ____ (date of satisfaction), and the affiant is responsible for cancellation of the same.
(Signature of affiant)
Sworn to (or affirmed) and subscribed before me this __________________ day of ___________________, 20 ____.
[Signature and seal of notary public or other official authorized to administer oaths].
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