| Assignor: |
(Assignor's name) |
| Assignor's Gender: |
Select Male or Female |
| Street Address: |
(Assignor's street address) |
| City: | |
| State/Province: |
(Select a U.S. state or Canadian province.) |
| Zip/Postal Code: | |
| Country: |
Select U.S.A. or Canada |
| Assignee: |
(Name of person receiving the mortgage assignment) |
| Assignee's Gender: |
Select Male or Female |
| Street Address: |
(Assignee's street address) |
| City: | |
| State/Province: |
(Select a U.S. state or Canadian province.) |
| Zip/Postal Code: | |
| Country: |
Select U.S.A. or Canada |
| Transfer Amount: |
(Indicate dollar amount of money assignee is paying to have the mortgage assigned to him/herself - e.g., $50,000.00) |
| Mortgagor: |
(Mortgagor's name) |
| Street Address: |
(Mortgagor's street address) |
| City: | |
| State/Province: |
(Select a U.S. state or Canadian province.) |
| Zip/Postal Code: | |
| Country: |
Select U.S.A. or Canada |
| Principal Sum: |
(principal amount of original mortgage, e.g. "$150,000.00") |
| Amount Owed: |
(Amount currently owed on mortgage) |
| Interest Rate: |
(Annual interest rate being paid on mortgage - e.g., 8.5%) |
| Date Mortgage Was Signed: |
(Date the mortgage was signed - e.g., December 12, 2001) |
| Date Recorded: |
(Date mortgage was recorded - e.g., December 20, 2000) |
| Business: |
(Name of business at which the mortgage was recorded) |
| Street Address: |
(Street address of business at which mortgage was recorded) |
| City: | |
| State/Province: |
(Select a U.S. state or Canadian province.) |
| Zip/Postal Code: | |
| Country: |
Select U.S.A. or Canada |
| Witness: |
(Name of first witness to sign mortgage assignment) |
| Witness: |
(Name of second witness to sign mortgage assignment) |
| Date Signed: |
//
(Select the day, month and year the mortgage assignment is signed.) |
|
