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'`v .INS'•/7 . <br /> COUNTY OF HAWAII <br /> Honoka'a Sewer Connection Guaranteed Loan Program <br /> Request for Payment of Guaranteed Loan and <br /> Assignment of Note and Mortgage <br /> is a designated bank under the Honoka'a Sewer Connection Loan <br /> Program as evidenced by the Agreement with Designated Banks ("Agreement") dated <br /> . Under the terms and conditions of the Agreement, we certify that the <br /> loan is in default and request a payoff of the following loan. <br /> Guaranteed Borrower: <br /> Property Address: <br /> TMK: <br /> Loan Balance: <br /> Accrued interest through : $ <br /> In consideration of the sum of Dollars ($ ), the designated <br /> bank hereby releases any claims on the guaranteed borrower under this loan, and <br /> assigns and transfers that certain Note and Mortgage dated for <br /> the original sum of Dollars ($ ) and which Mortgage is <br /> recorded on the public records in the State of Hawaii on Document No. <br /> to the County of Hawai'i with all its rights, title, and interest. The <br /> designated bank hereby warrants and represents that it is the present holder of the <br /> above described Mortgage and that there are no other holders of said Mortgage or any <br /> interest therein. <br /> Name of Designated Bank <br /> By: <br /> Printed Name: <br /> Title: <br /> County of Hawaii is an Equal Opportunity Provider and Employer. Complaints of discrimination should be sent to: <br /> USDA,Director,Office of Civil Rights,Washington,DC 20250-9410. Or call(202)720-5964(Voice and TDD). <br />