Authority for the clerk to cancel entries of other liens, mortgages, encumbrances, special claims, and like matters may be conferred by the execution by the person in whose favor such matters exist or his personal representative of a request as follows:
REQUEST TO CANCEL ENTRY
To the Clerk of the Superior Court of County:
You are directed to cancel the entry registered in my favor on
certificate of title No. , Registered Title No. , claiming the
following lien (encumbrance or special right, as the case may be)
This day of , .
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