Report Of Mediation {6}

VTB MM Form # 6 12/16/11 UNITED STATES BANKRUPTCY COURT DISTRICT OF VERMONT _________________________________________ In re [____________________], Case # _______ Chapter __ Debtor(s). REPORT OF MEDIATION* Name of Lender: ______________________________________ Date of Mortgage: ________________ Last Four Digits of Loan Account Number: ________________ Current Loan Balance:_____________ Property Address: _____________________________________ Date of Mediation Order: __________ Name of Mediator: ____________________________________ Date of Mediation: ________________ 1. Attached hereto is a list of the names or each person who participated in the mediation session(s) held on [insert date(s)], with their respective roles and contact information. 2. The Creditor's representative at the mediation session(s) did / did not have decision-making authority. 3. All parties participated in good faith [or, if not, details are set out here]. 4. The mediation was completed [or if not, details set out as to why it was not completed]. 5. The use of the mediation in this case has resulted in the following (check appropriate box): Loan Modification Describe all changes to terms of the loan documents, whether it is temporary or permanent, when it takes effect, and any conditions applicable to the modification. Short Sale (to be concluded by ___ with payment to the Creditor in amount of $___) Surrender of property (by [date]) Other agreement (specify): No agreement has been reached. Date: ______________ By :_________________________ Signature [or /s/ + typed name] Printed Name Address, E-Mail Address, Phone Number, Fax Number ____________ * This Report is to be filed by the Mediator within 14 days of the conclusion of the mediation. American LegalNet, Inc. www.FormsWorkFlow.com