Debtor Loss Mitigation Affidavit

UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF NEW YORK ------------------------------------------------------------------x In re: Chapter Case No. () Debtor(s). ------------------------------------------------------------------x DEBTOR LOSS MITIGATION AFFIDAVIT STATE OF NEW YORK COUNTY OF ) )ss.: ) I, _____ , being sworn, say: I am not a party to this action, am over 18 years of age and reside in ________, New York. On ______ , I served a true and completed copy of the documents requested in the "Creditor Loss Mitigation Affidavit,"1 dated____, upon the following parties via (first class mail, facsimile or email)_____ at the following addresses____ ; including the following documents: A copy of the Debtor's2 two (2) most recent federal income tax returns; A copy of the Debtor's last two (2) paycheck stubs, proof of social security income, pensions, or any other income received by the Debtor; Or, if Debtor is self-employed: A copy of the Debtor's business' two (2) most recent months' profit and loss statements, setting forth a breakdown of the monthly business income and expenses for [the months of]; A copy of the mortgagee=s completed financial worksheet; Proof of second/third party income by affidavit of the party, including the party's last two (2) paycheck stubs, Other (please specify) Italicized words in quotations indicate that there is a form by the same name on the Bankruptcy Court's website. These forms shall be used whenever applicable. 2 Unless otherwise provided herein, all capitalized terms are defined in the Southern District of New York's Loss Mitigation Program Procedures. The Loss Mitigation Program Procedures' definition of "Debtor" includes joint debtors. American LegalNet, Inc. www.FormsWorkFlow.com 1 Dated: , 20 , New York 2 American LegalNet, Inc. www.FormsWorkFlow.com