File No. Abstract No. STATE OF NORTH CAROLINA Judgment Docket Book & Page No. County Name Of Plaintiff(s) CERTIFICATE OF PAYMENT/ SATISFACTION OF JUDGMENT VERSUS Name Of Defendant(s) BY JUDGMENT CREDITOR PAYMENT IN FULL PARTIAL PAYMENT G.S. 1-239(c) TO THE CLERK OF SUPERIOR COURT: I certify that: 1. I am or represent the plaintiff/judgment creditor. defendant/judgment creditor in the above action. 2. a. the judgment in the above action has been PAID AND SATISFIED IN FULL and I authorize you to note this satisfaction in your judgment records. Amount Of Partial Payment b. a partial payment on the judgment in the above action in the amount set forth to the side $ has been made on the date indicated and I authorize you to note this partial payment in Date Of Partial Payment your records. ATTORNEY FOR JUDGMENT CREDITOR Date Signature Of Attorney For Judgment Creditor Attorney Bar No. Name Of Attorney For Judgment Creditor (Type Or Print) INDIVIDUAL JUDGMENT CREDITOR PARTNERSHIP JUDGMENT CREDITOR Date Date Name Of Partnership (Type Or Print) Signature Of Individual Judgment Creditor Signature Of Partner Authorized To Cancel Judgment Name Of Individual Judgment Creditor (Type Or Print) Name Of Partner Signing (Type Or Print) CORPORATE JUDGMENT CREDITOR Date Name Of Corporate Judgment Creditor (Type Or Print) Signature Of Person Signing Signature Of Secretary Of Corporation Name Of Person Signing (Type Or Print) ATTEST: Title Of Person Authorized To Cancel Judgment CORPORATE SEAL Secretary Assistant Secretary MULTIPLE JUDGMENT CREDITORS OR PARTNERSHIPS NOTE: All judgment creditors must sign. Date Signature Of Multiple Judgment Creditor 1 Date Signature Of Multiple Judgment Creditor 3Name Of Multiple Judgment Creditor 1 (Type Or Print) Name Of Multiple Judgment Creditor 3 (Type Or Print) Date Signature Of Multiple Judgment Creditor 2 Date Signature Of Multiple Judgment Creditor 4Name Of Multiple Judgment Creditor 2 (Type Or Print) Name Of Multiple Judgment Creditor 4 (Type Or Print) VERIFICATION I, the undersigned being first duly sworn, say that I have read this Certificate and the contents are true to my own knowledge, except as to matters stated on information and belief, and as to those, I believe them to be true. Date SWORN AND SUBSCRIBED TO BEFORE ME Date Signature Of Person Authorized To Administer OathsSignature Of Person Signing Certificate Deputy CSC Assistant CSC Clerk Of Superior Court Date My Commission Expires SEAL Notary AOC-CV-413, Rev. 9/03 2003 Administrative Office of the Courts