I [or We], _____________, declare that I am [or we are] the true and lawful holder [or holders] of the claim [or part of the claim, and specify what part] secured by the instrument within recorded, and hereby acknowledge the satisfaction thereof and discharge of the lien to secure the same in full [or if one part, state what part].
This __________ day of _________, 20_____.
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[Acknowledgment]
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