Certification Of Payment History On Note And Mortgage {OLR4001}

UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF NEW YORK In re Debtor Employer's Tax Identification No(s). [if any] Last four digits of Social Security No(s): Case No. Chapter CERTIFICATION OF PAYMENT HISTORY ON THE NOTE AND MORTGAGE DATED________________ AND RELATED INFORMATION _________________________, of full age, employed as ____________________ by ______________________________, hereby certifies the following information: Mortgage Recorded on: __________, in ___________ County, in Book ____ at Page ____ Property Address: Mortgage Holder: Movant's relationship to Mortgage Holder: Mortgagor(s)/Debtor(s): Bankruptcy Petition filed on: First Post-Petition Mortgage Payment Due: POST-PETITION PAYMENT HISTORY: Amount Due 1. 2. 3. 4. 5. 6. 7. 8. O:LR4001(12/12/2011) American LegalNet, Inc. www.FormsWorkFlow.com Date Payment Was Due How Payment was Applied (Mo./Yr.) Amount Received Date Payment Check or Received Money Order Number 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. TOTAL MONTHLY POST-PETITION PAYMENTS PAST DUE: [Number of Payments Past Due] ___________ multiplied by [Monthly Payment Amount, Exclusive of Late Charges and Other Charges] ___________ = ___________ Due as of _________. Itemize Past-Due Late Charges and Other Additional Charges Below. Attach a separate sheet, if necessary. Type of Charge Date Incurred Relative to Payment Due On Amount Total Additional Charges Amount Due EACH CURRENT MONTHLY PAYMENT IS COMPRISED OF: Principal.................. Interest................... R.E. Taxes............... Insurance................. Late Charge.............. _____________ _____________ _____________ _____________ _____________ 2 American LegalNet, Inc. www.FormsWorkFlow.com Other...................... TOTAL................... _____________ _____________ (Specify) If the monthly payment has changed during the pendency of the case, please explain (attach a separate sheet, if necessary): MONTHLY PRE-PETITION PAYMENTS PAST DUE: [Number of Payments Past Due] [From Date] [To Date] multiplied by [Monthly Payment Amount Inclusive of Late Charges and Other Charges] ____________ = ____________ Due as of ___________. REQUIRED ATTACHMENTS TO MOTION Please attach the following documents to your motion and indicate the exhibit number associated with the documents. (1) Copies of documents that indicate Movant's interest in the subject property. For purposes of example only, a complete and legible copy of the promissory note or other debt instrument together with the complete and legible copy of the mortgage and any assignments of the note and mortgage in the chain of title from the original mortgagee to the current moving party. (Exhibit _____.) (2) Copies of documents establishing that Movant's interest in the real property or cooperative apartment was perfected. For the purposes of example only, a complete and legible copy of the Financing Statement (UCC-1) filed with either the Clerk's Office of the Register of the county the property or cooperative apartment is located in. (Exhibit _____.) CERTIFICATION FOR BUSINESS RECORDS I CERTIFY THAT THE INFORMATION PROVIDED IN THIS FORM AND/OR ANY EXHIBITS ATTACHED TO THIS FORM (OTHER THAN THE TRANSACTIONAL DOCUMENTS ATTACHED AS REQUIRED BY PARAGRAPHS 1 AND 2 IMMEDIATELY ABOVE) IS DERIVED FROM RECORDS KEPT IN THE COURSE OF REGULARLY CONDUCTED ACTIVITY, MADE AT OR NEAR THE TIME OF THE OCCURRENCE OF THE MATTERS SET FORTH BY OR FROM INFORMATION TRANSMITTED BY, A PERSON WITH KNOWLEDGE OF THOSE MATTERS, AND WERE MADE BY REGULARLY CONDUCTED ACTIVITYAS REGULAR PRACTICE. I FURTHER CERTIFY THAT THE COPIES OF ANY TRANSACTIONAL DOCUMENTS ATTACHED TO THE MOTION AS REQUIRED BY PARAGRAPHS 1 AND 2 IMMEDIATELY ABOVE, ARE TRUE AND ACCURATE COPIES OF THE ORIGINAL 3 American LegalNet, Inc. www.FormsWorkFlow.com DOCUMENTS THAT ARE IN THE POSSESSION OF THE MOVANT, EXCEPT AS FOLLOWS: __________________________. I,_____________________________________<NAME AND TITLE> OF ______________________________ <NAME OF MOVANT>, DECLARE (OR CERTIFY, VERIFY, OR STATE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. EXECUTED AT ____________________ <CITY/TOWN>, ____ <STATE> ON THIS ____ DAY OF , 20_____ . _________________________________________ [Print Name, Title, Name of Movant, Movant's Street Address, City, State, and Zip Code Below} 4 American LegalNet, Inc. www.FormsWorkFlow.com