(Statutory Form)
I hereby certify, under penalties of perjury, that the within (or attached) note(s) are the only original note(s) secured by a deed of trust recorded among the Land Records of
___________ in Liber __________ folio __________; and that I received the said note(s) from [here enter name of holder] after satisfaction of the debt secured thereby.
___________________________ [Affiant]
[Acknowledgment]
No guidelines are available for this form at this time.