Delinquent taxes and assessments shall be noted on the title register when the officer charged with the collection of taxes files with the clerk a certificate substantially in the following form:

NOTATION OF DELINQUENT TAXES

I certify that ______________ (state, county, or city, as the case may be) has a lien for unpaid taxes (or assessments, as the case may be) for the year ____ against the land described in certificate No. ________, Registered Title No. ________, registered in the office of the clerk of the Superior Court of ________ County, in the amount of $________. The clerk will please note the same on the title register.

This ______ day of ______________, ____.

_______________ Tax Collector