Affidavit to Accompany Recording of Unacknowledged Or Incomplete Discharge of Mortgage Under M

Affidavit to Accompany Recording of Unacknowledged or Incomplete Discharge of Mortgage under M.G.L. c. 183, §54(b)

I, , of , having personal knowledge of the facts herein stated, state on oath as follows:

1. This affidavit is given in connection with a Mortgage from to , dated , , and recorded with Registry of Deeds at Book , Page , and/or registered with

Registry District of the Land Court as Document No. , noted on Certificate of Title No. , covering property located at [street], [city/town], Massachusetts [referred to herein as the "Mortgage"]

2. This affidavit accompanies an instrument [referred to herein as the "Discharge"] dated , , executed by evidencing the satisfaction in full of the obligation and secured by the mortgage. The Discharge is not in a form acceptable for recording, and the undersigned certifies that a recordable discharge of the Mortgage is not available. This affidavit is presented for recording as a corroborating affidavit in support of the recording of the Discharge, in accordance with applicable provisions of M.G.L. c.183, §54(b).

3. The following corroborating documents or affidavits, listed below and attached hereto, are offered as credible evidence to prove the authenticity and due execution of the Discharge by ______as mortgagee, mortgage note holder or mortgage servicer or an employee or agent of same, for the purpose of recording the Discharge in the absence of an acknowledgement or other information required for recording in accordance with the provisions of M.G.L. c.183, § 54(b).

a) ______

b) ______

c) ______

d) ______

Signed under the penalties of perjury, this day of , 20 .

[Name of Affiant and Title]

COMMONWEALTH OF MASSACHUSETTS

______, ss

On this ______day of ______, 20____, before me, the undersigned notary public, personally appeared ______, proved to me through satisfactory evidence of identification, which was ______

______, to be the person who signed the preceding or attached document in my presence, and swore or affirmed to me that the contents of the document are truthful and accurate to the best of his/her knowledge and belief.

______

, Notary Public

My commission expires

(11-13-2007) REBA Form No 40