Declaration Regarding Request To Pay Post-Petition Mortgage Obligations {4001-b}

TXEB Local Form 4001-b (effective 11-1-12) IN THE UNITED STATES BANKRUPTCY COURT FOR THE EASTERN DISTRICT OF TEXAS IN RE: NAME OF DEBTOR Last 4 Digits of Tax ID No. Debtor's Address Debtor § § § § § § § Case No. xx-xxxxx Chapter 13 DECLARATION OF DEBTOR UNDER PENALTY OF PERJURY REGARDING REQUEST TO PAY POST-PETITION MORTGAGE OBLIGATIONS THROUGH CHAPTER 13 PLAN MODIFICATION I, as one of the Debtor(s) in the above-referenced case, owe a debt secured only by a security interest in real property that is my/our principal residence (a "mortgage debt") and have fallen in arrears on that obligation, in contravention of our obligations under my/our confirmed Chapter 13 plan. We will be seeking the Court's permission to modify that confirmed plan to address these post-petition obligations and, in support of that request, declare under penalty of perjury that the following statements are true and correct: NUMBER OF POST-PETITION MONTHS IN ARREARS: ______ CALENDAR RANGE OF ARREARAGES: from [month], [year] to [month], [year]. REASON FOR ARREARAGES: [] [] [] Loss of Post-Petition Income Unbudgeted Medical Expenses Other Hardship DETAILED EXPLANATION: Date:________________ Signature:___________________________________ Debtor1 1 The signature of one debtor in a joint debtor case shall be sufficient for this form. American LegalNet, Inc. www.FormsWorkFlow.com