S. A. & I. No. 443 (rev. 2002)
MORTGAGE TAX INFORMATION
DATE OF MORTGAGE:____________________________________________
AMOUNT OF MORTGAGE:_________________________________________
LEGAL DESCRIPTION or TREASURER'S ACCOUNT NO._________________________________________________________________
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.
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.