OKCountyTreasurers.com

S. A. & I. No. 443 (rev. 2002)

MORTGAGE TAX INFORMATION

MORTGAGOR:____________________________________________________

MORTGAGEE:____________________________________________________

DATE OF MORTGAGE:____________________________________________

MATURITY DATE:_________________________________________________

AMOUNT OF MORTGAGE:_________________________________________

LEGAL DESCRIPTION or TREASURER'S ACCOUNT NO._________________________________________________________________

ASSEVERATION

I hereby validate that the facts and figures provided in the above mortgage tax

information are true and correct, to the best of my knowledge.

_____________,20____

 

Signature of Mortgagee___________________________

This form must accompany any mortgage document presented to County Treasurer for payment of the

Mortgage Registration Tax required by the provisions of 68 Okl.St.Ann. §1904. Failure to include this form

may result in the delayed filing of your instruments. This form is not required on transactions that are

deemed to be exempt from Mortgage Registration Tax.