RELEASE BY OBLIGEE OF RECORD

(PURSUANT TO R.S. 9:5169)

STATE OF LOUISIANA

PARISH OF BOSSIER

BE IT KNOWN that on this ________day of ______ _, 2022, before me the

undersigned Notary, duly commissioned and qualified in and for the above named Parish

and State,

PERSONALLY CAME AND APPEARED:

Represented herein by:__________________________________________if applicable)

Title:___________________________________, its duly authorized representative, who

after being duly sworn declared:

(Please initial the appropriate box)

( ) The above named appearer is the obligee of record of the obligation secured by

the below described mortgage or privilege.

( ) The above named appearer is the assignee of record of the obligation secured by

the below described mortgage or privilege. Said Assignment is duly recorded at:

Registry Number ___________ MOB ______ Folio _____

The said secured obligation has been paid or otherwise satisfied or extinguished and

further the said mortgage or privilege is hereby released.

The Recorder of Mortgages in and for the Parish of BOSSIER is hereby requested,

authorized and directed to cancel the recordation of the mortgage or privilege described

as follows:

Mortgage/Privilege/Encumbrance: granted by/against _________________________

In favor of ___________________________________________________________

Registry Number______________________________________________________

of the official records of BOSSIER Parish, Louisiana, which affects the following

described property:

WITNESSES: SIGNATURE: _______________________

PRINTED NAME:

________________________ COMPANY NAME:

TITLE:

________________________ ADDRESS:

Sworn to and subscribed before me this________day of______________________2022.

_______________________________________

Notary Public

Printed Name:

ID or Bar Roll Number:

Commission Expires: