State of South Carolina, County of ___________ : John Doe to Richard Roe. Mortgage dated _______, 20_______ ; recorded _________ ; amount $_________. I, ________, sole owner and holder of the above described mortgage hereby declare same to be fully satisfied and the lien thereof forever discharged.
Witness my hand and seal this _______ day of ________, 20______.
Signed, sealed and delivered in the presence of:
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