This Request for Cancellation of Statement of Claim and Privilege form is for use by an individual who has filed a Statement of Claim and Privilege to request that the recorder of mortgages cancel the Statement of Claim and Privilege from his or her records. This request provides the date on which the individual received a written request from the owner or other interested person to give this Request as the Statement of Claim and Privilege had either been improperly filed or the claim or privilege preserved by the filing of the Statement of Claim and Privilege had been extinguished. The individual must deliver this Request within ten days of receipt of such written request.