SAMPLE FORM

____________________________________________________________¹
 (SPACE ABOVE RESERVED FOR RECORDING INFORMATION)

            Buck Daniel McSween,  20 F Avenue,  Harper, OH  45011  (999) 774-2233² 
(RESERVED FOR NAME, ADDRESS, AND TELEPHONE NUMBER
OF PERSON PREPARING INSTRUMENT)

RELEASE OF MORTGAGE

            The undersigned, as holder of the Mortgage executed by                                       
            Carol Ann Walker³                                  (name), and dated       April 1st, 2001⁴          ,
 acknowledged            April 1st, 2001⁵                 (date), and recorded     April 1st, 2001⁶    
 (date) at the office of                    Buck Daniel McSween⁷                 in          Clint⁸                
 County, State of              Ohio⁹                            , in           vol. 213, pg. 429¹⁰                    (book,
 volume, page or other reference number where Mortgage was recorded) acknowledges that
 said Mortgage is fully discharged, paid, redeemed, released, and satisfied in full.

            All words and phrases contained in this instrument (and the attached
 Acknowledgment, if any) shall be construed in the singular, plural, masculine, feminine
 or neuter according to the context.

This is not a substitute for legal advice.  An attorney must be consulted.
Copyright © 1994 - 2014 by LAWCHEK, LTD.

RELEASE OF MORTGAGE FORM cont'd.

 Date:                 12/12/01¹¹                          

 ________________________________¹²      ________________________________¹³
 Holder of Mortgage                                            Holder of Mortgage

   77 3rd Street SE,  Harper, OH  45011  ¹⁴      ________________________________¹⁵
 Address                                                              Address

 ________________________________¹⁶       ________________________________¹⁷
 Witness (If required by law)                                Witness (If required by law)

 ________________________________¹⁸       ________________________________¹⁹
 Witness (If required by law)                                Witness (If required by law)

 Attach Acknowledgment If Required By Law.

This is not a substitute for legal advice.  An attorney must be consulted.
Copyright © 1994 - 2014 by LAWCHEK, LTD.

1. This space is reserved for the county and/or state officials' use.
2. The name, address and telephone number of the lawyer or banker preparing the document.
3. The full name of the mortgagor.
4. The date on which the document is signed.
5. The date on which the document was signed/acknowledged by a notary public.
6. The date on which the document was recorded.
7. The location at which the document was recorded.
8. The county in which the document was recorded.
9. The state in which the document was recorded.
10. The source where the document is kept, referenced similarly to the example.
11. The date on which the release is signed.
12. The signature of the holder of the mortgage.
13. The signature of the second holder of the mortgage.
14. The address of the holder of the mortgage.
15. The address of the second holder of the mortgage.
16. The signature of a witness.
17. The signature of a witness.
18. The signature of a witness.
19. The signature of a witness.