a. Name of mortgagor or obligor of the privilege as it appears in the recorded mortgage or vendor’s privilege and recordation information.

          b. Description of the paraphed note and property

          c. That the affiant or someone under his direction did satisfy the note

          d. That the affiant or someone under his direction:

                    Did receive the note marked “Paid in Full” from the last holder of the note, and that the note was lost or destroyed while in the affiant’s custody

                    or

                    Has confirmed that the last holder of the note received payment in full and sent the note and the note was never received.

          e. That the affiant agrees to be personally liable and to indemnify the recorder of mortgages and any person relying upon the cancellation by affidavit for any damages that they may suffer as a consequence of such reliance if the recorded affidavit contains materially false or incorrect statements that cause the recorder to incorrectly cancel the recordation of a mortgage or privilege.