State. of New Jersey
County of ____________ ss.:

The undersigned, being duly sworn upon the undersigned’s oath, avers as follows:

1. I am: (a) an attorney-at-law duly admitted to practice before the Courts of this State; or (b) duly licensed as an insurance producer in the line of title insurance.
2. On ___________________________, I caused to be sent to ___________ _______________________, located at ________________________________, the sum of $_____________.____ , in full payment of a certain mortgage dated __________, 19 in the face amount of $____________, between____________________________________________________ (mortgagor)and_____________________________ (mortgagee), which mortgage was recorded on _________________ _____ in the Office of the Clerk / Register of the County of ________________ in Mortgage Book ______, page _____ (and which mortgage was subsequently assigned to _________________________ ________________ by assignment of mortgage dated ________, 19 recorded ________ ____, 19__, in Assignment of Mortgage Book ____ page ____.
3. Said payment was made by check or electronic wire transfer, in accordance with a pay-off letter received from ______________________________________________________________ dated __________, _____; and I have received advice that (a) the check has been negotiated and canceled on ____________________________ or (b) the wire transfer was received and credited to the recipient’s account on ______________.
4. On _________, _____, at least thirty (30) days having elapsed since the date the payment was received, I caused a notice to be sent to _______________________, located at _______________________ (the address designated for receipt of payment in the pay-off letter, or, if no address is designated, the address given on the letter head of the payoff letter), by registered or certified mail, return receipt requested, pursuant to section 2 of P.L. 1975, c. 137 (N.J.S.A.46:18-11.3).
5. On _________, _____, at least thirty(30) days having elapsed since the date the notice as set forth in paragraph 4 of this affidavit was received, I caused a notice to be sent to _____________ located at ___________________________________ ____________________ (the address designated for receipt of payment in the pay-off letter, or if no address is designated, the address given on the letter head of the pay-off letter), by registered or certified mail, return receipt requested, of my intention to cause the mortgage to be discharged by affidavit, pursuant to Section 3 of P.L. 1999, c. 40 (N.J.S.A. 46:18-11.7), if the mortgage remains unconcealed 15 days after the notice is received.
6. At least fifteen (15) days have now elapsed since the notice described in paragraph 5 of this affidavit was received. To the best of my knowledge and belief, no letter or other written communication has been received from _______________________ to the effect that it denies or disputes that the mortgage has been paid in full and ought to be discharged of record at this time.
7. Wherefore, the undersigned directs the county clerk or register of deeds of the County of _________________ to cause to be recorded the discharge or satisfaction-piece accompanying this affidavit, and further directs the county clerk or register of deeds to cause a marginal notation of discharge to be made upon the record of the mortgage described in paragraph 2 of this affidavit.

Sworn and subscribed before me this ___________ day of _______________ , _______ ___________________________________________________________________________

*Statutory form; affidavits submitted for recording must be substantially similar to the text set forth in the statute, which is reproduced herein.

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Example of First Notice to Holder of Mortgage || Example of Second Notice to Holder of Mortgage
Example Affidavit of Payment to Discharge Mortgage || Example of Discharge of Mortgage by Affidavit of Payment