The Property (Discharge of Mortgage by Receipt) (Northern Ireland) Order 1983

Article 3 (3).

SCHEDULE N.I. FORM OR RECEIPT ON DISCHARGE OF A MORTGAGE

M., of [etc.] hereby acknowledges the receipt of all moneys [or the balance remaining owning in respect of moneys] secured by the within [or above] [or annexed] written deed.

Dated this .................... day of .................... 19....................

  M. [signature or seal of mortgagee]

M. signed this receipt of discharge in our[F1 or my] presence.

F1 1992 NI 7

  W. [signatures of witnesses [F2 or witness]] [addresses and occupations or description of witnesses [F2 or address and description as a solicitor of witness]]

F2 1992 NI 7

1.  The mortgage is comprised of the following deed or deeds. N.I.

Date	Description	Serial Number in Registry of Deeds

2.  The mortgagee executing the receipt is the original mortgagee. N.I.

OR

The mortgagee executing the receipt derives title under the original mortgagee as follows—

[Here state the manner in which title is derived, listing all relevant instruments.]

Date	Description	Serial Number in Registry of Deeds