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Proof Of Claim Attachment A Mortgage Proof Of Claim Attachment B10A - Official Federal Forms
| Proof Of Claim Attachment A Mortgage Proof Of Claim Attachment Form. This is a national form and can be used in General Bankruptcy . |
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B 10A (Attachment A) (12/11) Mortgage Proof of Claim Attachment If you file a claim secured by a security interest in the debtor's principal residence, you must use this form as an attachment to your proof of claim. See Bankruptcy Rule 3001(c)(2). Name of debtor: Name of creditor: _______________________________________ _______________________________________ Case number: Last four digits of any number you use to identify the debtor's account: ___________________________ ____ ____ ____ ____ Part 1: Statement of Principal and Interest Due as of the Petition Date Itemize the principal and interest due on the claim as of the petition date (included in the Amount of Claim listed in Item 1 on your Proof of Claim form). 1. Principal due 2. Interest due Interest rate _________% _________% _________% From mm/dd/yyyy (1) $ ____________ To mm/dd/yyyy Amount __________ __________ __________ _________ _________ _________ $ _______ $ _______ + $ _______ $ _______ Copy total here (2) (3) Total interest due as of the petition date 3. Total principal and interest due + $ ____________ $ ____________ Part 2: Statement of Prepetition Fees, Expenses, and Charges Itemize the fees, expenses, and charges due on the claim as of the petition date (included in the Amount of Claim listed in Item 1 on the Proof of Claim form). Description 1. Late charges 2. Non-sufficient funds (NSF) fees 3. Attorney's fees 4. Filing fees and court costs 5. Advertisement costs 6. Sheriff/auctioneer fees 7. Title costs 8. Recording fees 9. Appraisal/broker's price opinion fees 10. Property inspection fees 11. Tax advances (non-escrow) 12. Insurance advances (non-escrow) 13. Escrow shortage or deficiency (Do not include amounts that are part of any installment payment listed in Part 3.) 14. Property preservation expenses. Specify:______________ 15. Other. Specify:_____________________________________ 16. Other. Specify:_____________________________________ 17. Other. Specify:_____________________________________ Dates incurred Amount (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) + (18) ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ 18. Total prepetition fees, expenses, and charges. Add all of the amounts listed above. American LegalNet, Inc. www.FormsWorkFlow.com B 10 (Attachment A) (12/11) Page 2 Part 3. Statement of Amount Necessary to Cure Default as of the Petition Date Does the installment payment amount include an escrow deposit? No Yes Attach to the Proof of Claim form an escrow account statement prepared as of the petition date in a form consistent with applicable nonbankruptcy law. 1. Installment payments due Date last payment received by creditor _____________ mm/dd/yyyy Number of installment payments due (1) ___________ $ ____________ $ ____________ 2. Amount of installment payments due ______installments @ ______installments @ ______installments @ Total installment payments due as of the petition date + $ ____________ $ ____________ Copy total here (2) $ _____________ 3. Calculation of cure amount Add total prepetition fees, expenses, and charges Copy total from Part 2 here + $ _____________ Subtract total of unapplied funds (funds received but not credited to account) - $ _____________ - $ _____________ (3) Subtract amounts for which debtor is entitled to a refund Total amount necessary to cure default as of the petition date $ _____________ Copy total onto Item 4 of Proof of Claim form American LegalNet, Inc. www.FormsWorkFlow.com
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