GA Cancellation of Security Deed (Statutory Form)

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State of Georgia           )

County of _______     )

                                                                                    CROSS REFERENCE:

Cancellation of Security Deed (Statutory Form)

The indebtedness referred to in that certain deed to secure debt from ______________________ to ____________________________________, dated ________________, and of record in Deed Book _________, Page _______, in the office of the clerk of the Superior Court of ____________ County, Georgia, having been paid in full and the undersigned being the present holder and owner of such deed by virtue of being the original grantee or by virtue of assignment(s) of record in Deed Book(s) _____, Page(s) _____, (show all assignments, the clerk of such superior court is authorized and directed to cancel that deed of record as provided in Code Section 44-14-4 (GCA §67-117) for other mortgage cancellations.

In witness whereof, the undersigned has set his or her hand and seal this ______ day of ___________, 20__.

Signed, sealed and delivered                                        ________________________________

in the presence of:                                                       Signature                                  (SEAL)

_____________________________________
Unofficial Witness

_____________________________________                     
Notary Public                                                              

My Commission Expires: