CERTIFICATE AND AFFIDAVIT OF SATISFACTION COMMONWEALTH OF VIRGINIA VA. CODE §§ 55-66.3 to 55-66.6 ..................................................................................................................................................... Circuit Court is the location of the following record referenced by this certificate: ........................................................................ DATE, [ ..................... DEED BOOK NO. ........................ PAGE NO. ................................. INSTRUMENT NUMBER ] DEED OF TRUST [ ] OTHER LIEN or ................................................................... TAX MAP REFERENCE NUMBER ............................................................................................. PARCEL IDENTIFICATION NUMBER ........................................................................................................................................................................ NAME(S) OF GRANTOR(S)/MAKER(S) ........................................................................................................................................................................ NAME(S) OF TRUSTEE(S) $ .................................................................................... AMOUNTS AND TOTAL OF NOTE(S) I/WE, lien creditor, settlement agent, or title insurance company, who made payment in satisfaction of the above-mentioned note(s) secured by the above-mentioned deed of trust or other lien, do hereby certify that the same has/have been paid in full, and the lien therein created and retained is hereby released. ............................................................ DATE ___________________________________________________________________________ AUTHORIZED SIGNER ____________________________________________________________________ [] [] [] LIEN CREDITOR SETTLEMENT AGENT (CRESPA Registration No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ) (Settlement Agent's AFFIDAVIT and NOTICE OF INTENT is attached.) Pursuant to authority granted by Virginia Code § 55-66.3(E) TITLE INSURANCE COMPANY (Title Insurance Company's Affidavit and Notice of Intent is attached.) Pursuant to authority granted by Virginia Code § 55-66.3(E) State/Commonwealth of ............................................. [ ] City [ ] County of ..................................................... Acknowledged, subscribed and sworn to before me this . . . . . . . . . . . . . . . . . . . day of by ............................................. , 20 ........... ................................................................................................................................................................... LIEN CREDITOR, SETTLEMENT AGENT OR TITLE INSURANCE COMPANY .............................................................................. PRINTED NAME OF NOTARY PUBLIC _________________________________________________________ SIGNATURE OF NOTARY PUBLIC (My commission expires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ) Registration No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VIRGINIA: IN THE CLERK'S OFFICE OF THE CIRCUIT COURT This certificate and affidavit of satisfaction was presented and, with the Certificate annexed, admitted to record on ............................................ DATE at . . . . . . . . . . . . . . . . . . . . . . m. TIME Clerk's fee of $ .......................... have been paid. by___________________________________ Deputy Clerk ______________________________________ , Clerk FORM CC-1505 MASTER 11/11 American LegalNet, Inc. www.FormsWorkFlow.com