Virginia Code § 8.01-241.1

Permissible form for certificate
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Any extension of the limitations of the right to enforce the lien of a deed of trust or mortgage shall conform substantially with the following form:
CERTIFICATE OF EXTENSION OF LIMITATION OF RIGHT TO ENFORCE DEED OF TRUST OR MORTGAGE
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.
...........................................................…
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
1994, c. 547; 2008, c. 226.

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