Certification Re Post-Petition Payment History {16}

UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY Caption in Compliance with D.N.J. LBR 9004-2(c) In Re: Case No.: Chapter: Hearing Date: Judge: __________________ __________________ __________________ __________________ CERTIFICATION RE POST-PETITION PAYMENT HISTORY ON THE NOTE AND MORTGAGE DATED ______________________ __________________________________ of full age, employed as _________________________________________ by _________________________________________, hereby certifies the following information: Recorded on ___________________, in ________________ County, in Book __________ at Page __________ Property Address: ___________________________________________________________________________ Mortgage Holder: ___________________________________________________________________________ Mortgagor(s)/ Debtor(s): ____________________________________________________________________ POST-PETITION PAYMENTS (Petition filed on ____________________________) Amount Due 1. 2. 3. 4. 5. 6. 7. 8. American LegalNet, Inc. www.FormsWorkflow.com Date Payment Was Due How Payment Was Applied (Mo./Yr.) Amount Received Date Payment Received Check or Money Order Number Amount Due 9. 10. Date Payment Was Due How Payment Was Applied (Mo./Yr.) Amount Received Date Payment Received Check or Money Order Number TOTAL: [Continue on attached sheets if necessary.] MONTHLY PAYMENTS PAST DUE: ____________ x $ _____________________ (MONTHLY PAYMENT + LATE CHARGE) = $ ______________________________ AS OF ________________________. Each current monthly payment is comprised of: Principal .................... $ ____________________ Interest ....................... Insurance .................... ____________________ ____________________ (Specify) ________________________________________) R.E. Taxes .................. ____________________ Late Charge ................. ____________________ Other ........................... ____________________ TOTAL .................... $ ____________________ If the monthly payment has changed during the pendency of the case, please explain (attach separate sheet(s) if necessary): ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ PRE-PETITION ARREARS : ___________________ to ___________________ (______mos. x $ ___________/mo. = $ _______________) I certify under penalty of perjury that the foregoing is true and correct. ________________________________ Date of signature ________________________________ Signature Local Form 16. rev.8/1/06.jml American LegalNet, Inc. www.FormsWorkflow.com