(765 ILCS 935/55)

Sec. 55. Form of appointment of title insurance agent for issuance of certificates of release. A title insurance company shall use the following form for the appointment of its title insurance agents for the purpose of executing certificates of release pursuant to this Act. APPOINTMENT OF TITLE INSURANCE AGENT OR AGENTS FOR ISSUANCE OF CERTIFICATES OF RELEASE ..... (name of title insurance company) appoints .....

(name of title insurance agent or agents) to act as its agent or agents for the purpose of executing and delivering for recording certificates of release as provided by the Mortgage Certificate of Release Act. This appointment shall commence on ..... (date) and (select one) continue until revoked as provided by that Act / terminate on ..... (date). The agent or agents appointed has/have consented to and accept the terms of this appointment.

Dated this ..... (date).

By:

..... (title insurance company)

..... (signature)

..... (typed / printed name & title)

..... (address)

..... (telephone number)

State of Illinois)

)

County of )

This instrument was acknowledged before me on .....(date)

by .....(name of person) as .....(officer for / agent of)

.....(title insurance company).

.....

Notary Public

My commission expires on.....

(Source: P.A. 92-765, eff. 8-6-02.)