Notice of Request for Loss Mitigation – By Debtor (NJB NRLMD)

UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY Caption in Compliance with D.N.J. LBR 9004-2(c) ____________________________________________ In Re: Case No.: Chapter: Judge: ____________________ ____________________ ____________________ NOTICE OF REQUEST FOR LOSS MITIGATION ­ BY THE DEBTOR I am/ We are the debtor(s) in this case and hereby request loss mitigation with respect to: Property address: __________________________________________________________________________ Creditor is the holder of: first mortgage or second mortgage. I/We will make adequate protection payments to the above creditor each month in the following amount during the loss mitigation period: See Loss Mitigation Program and Procedures, Section V.A.1.a and VII.B. Creditor _____________________________ Amount: $ ______________ Due date: _______________ I/We request to be excused from using the Loss Mitigation Portal due to undue hardship as set forth in detail below: I understand that if the court orders loss mitigation in this case I am required to comply with the Loss Mitigation Program and Procedures and will participate in good faith. I understand that Loss Mitigation is voluntary, and that I am not required to enter into any agreement or settlement with any other party as part of this Loss Mitigation, and understand that no other party is required to enter into any agreement or settlement with me. I also understand that I am not required to request dismissal of this case as part of any resolution or settlement that is offered or agreed to during the Loss Mitigation Period. I also certify that the property in question consists only of real property in which I hold an interest used as a principal residence. American LegalNet, Inc. www.FormsWorkFlow.com Date: ______________________ __________________________________ Debtor __________________________________ Joint Debtor (if any) Date: ______________________ Debtor Information: Print full name: ______________________________________________________________________ Mailing address: _____________________________________________________________________ Telephone number: ___________________________________________________________________ Email address (if any): ________________________________________________________________ Debtor's Attorney Information: Name: _____________________________________________________________________________ Address: ___________________________________________________________________________ Telephone number: _________________________ Fax number: ______________________________ Email address (if any): ________________________________________________________________ Creditor Information: (if known) Name: _____________________________________________________________________________ Address: ___________________________________________________________________________ Telephone number: _________________________ Fax number: ______________________________ Email address (if any): ________________________________________________________________ Creditor's Attorney Information: (if known) Name: _____________________________________________________________________________ Address: ___________________________________________________________________________ Telephone number: _________________________ Fax number: ______________________________ Email address (if any): ________________________________________________________________ Pursuant to Section V.A.1.a. of the Loss Mitigation Program and Procedures, the above named creditor has 14 days to file with the court, and serve on the debtor, debtor's attorney and trustee, an objection to this Request. Revised 9/19/13 2 American LegalNet, Inc. www.FormsWorkFlow.com