CLERK OF CIVIL DISTRICT COURT FOR THE PARISH OF ORLEANS LAND RECORDS DIVISION (504) 407-0005 E-mail: 1340 Poydras Street, 4 Floor New Orleans, Louisiana 70112 TH civilclerklandrecords@orleanscdc.com Dale N. Atkins Clerk of Court And Ex-Officio Recorder Parish of Orleans REQUEST TO CANCEL INSCRIPTION The Clerk of Court and Ex-Officio Recorder for the Parish of Orleans, Dale N. Atkins, is hereby requested and authorized to cancel the following inscription(s): The inscription recorded as Instrument Number _________________________, Mortgage Instrument Number (MIN) _________________________, Mortgage Office Book (MOB) ______________________________ Folio ______________________ executed by ________________________________________________ dated ______________________ in favor of _____________________________________________________ being a (an) ______________________________________ of the ____________________________ recorded as Instrument Number _________________________ MIN _____________________ MOB _______________ Folio _______________ executed by _________________________________________________ in favor of ______________________________________ for the reason that the original obligation has been cancelled, but through inadvertence the above inscription remains open. _________________________________________ NAME (PRINT) _________________________________________ _________________________________________ _________________________________________ ADDRESS _________________________________________ TELEPHONE _________________________________________ SIGNATURE _______________________________________ DATE American LegalNet, Inc. www.FormsWorkFlow.com