Kansas Mortgage Registration Fee Affidavit Form

Transcript

The space above is reserved for REGISTER OF DEEDS MORTGAGE REGISTRATION FEE AFFIDAVIT K.S.A. 79-3102 (d)(3) STATE OF ) ) ) COUNTY OF SS: I, do state that I have personal knowledge of the statements and (PRINT NAME OF AFFIANT) representations set forth in this affidavit, and that the consideration stated in the mortgage tendered for filing is verified by this affidavit to be principal indebtedness covered or included in the previously recorded mortgage(s) listed below with the same lender or their assigns upon which the registration fee required by KSA 79-3101 et seq. has been previously paid. LIST MORTGAGES/INSTRUMENTS WHERE FEE PREVIOUSLY PAID: Lender’s Document Book Page Amt. of Indebtedness Total Indebtedness Paid On Additional Information: NEW MORTGAGE/INSTRUMENT TO BE RECORDED: Lender’s Name New Indebtedness $ Additional Indebtedness (New Indebtedness Less Indebtedness Previously Paid On) $ Affiant’s Signature: X PRINT NAME TITLE/COMPANY (SEAL) SUBSCRIBED AND SWORN TO before me on . DATE Expiration Date: Notary Public PLEASE ATTACH A COPY OF THE DOCUMENT PAGES THAT ARE REFERENCED FOR MOST TIMELY PROCESSING. The space below is reserved for REGISTER OF DEEDS