Know all Men by These Presents, that I, ____________, of __________, do hereby certify that a certain mortgage bearing date the ________ day of _________, 20_____,
made and executed by ________________, of ______________, to me, and recorded in the office of the clerk [or register] of the County of ___________, in book ________ of mortgages, page __________ on the ___________ day of _____________, at ________
o'clock _____.M., is paid and satisfied; and I do hereby consent that the same may be discharged of record.
Witness my hand and seal this _______ day of _____________, 20______.
Prepared by [name].
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