Virginia Code Title 8.01. Civil Remedies and Procedure § 8.01-241.1. Permissible form for certificate

Place of Record ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․

Date of Deed of Trust/Mortgage ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․

Deed Book ․․․․․․․․․․․․․․․․․․ Book Page ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․

Name of Guarantor(s) ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․

Name of Trustee(s) ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․

Maker(s) of Note ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․

Date of Note(s) ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․

    I/we, the beneficial title holder(s) of the property encumbered by the above mentioned deed of trust/mortgage, do hereby certify that the lien of the same is hereby extended 10 years from the date of my/our endorsement upon this certificate.

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Beneficial Titleholder/Attorney-in-Fact/Agent

Commonwealth of Virginia County/City of ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․:

Subscribed, sworn to and acknowledged before me by

․․․․․․․․․․․․․․․․․, this ․․․․ day of ․․․․․․․․, 20 ․․․

My Commission expires: ․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․․

Notary Public