Know All Men by These Presents, that I ___________ of the ___________, of ___________ County and State of _________, for and in consideration of the sum of ___________ dollars, and for other good and valuable considerations, the receipt whereof is hereby confessed, do hereby remise, release and discharge the premises hereinafter particularly described from the lien of a certain mortgage executed by ___________ to _________, dated __________, 20_______, recorded in __________, 20_____, in book _______, on page _______ of the records of __________ County, State of ________.
The above mentioned premises being situated in the __________ of ________ County of ___________ in the State of ____________ and particularly described as follows:
It is hereby expressly understood that this release shall not affect or impair the security of said mortgage upon any portion of any premises, except the premises hereinabove particularly described.
Witness my hand and seal this _________ day of _________, 20______.
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