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MOW 3094.1.3 (10/08)

IN THE UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF MISSOURI In re: ) ) ) ) )

Case No.

Debtor(s)

MORTGAGEE'S NOTICE OF FEES AND COSTS INCURRED­MORTGAGE __________________, a secured creditor in the above-referenced bankruptcy proceeding, hereby gives notice that fees and costs were incurred, [Insert Basis for Claim], in the amount of $_____________. That pursuant to the terms of the note and deed of trust, the debtor is required to pay these fees and costs. Documentation to support the fees and costs are attached hereto as Exhibit "A." Any questions regarding these fees and costs should be directed to:

Contact: _______________________ Name _______________________ Address _______________________ Address _______________________ Telephone

Date: _______________

___________________________________ Name Address Telephone Number Facsimile E-mail

CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing Notice has been served electronically via the Court's ECF system and by first class mail on: Date: ____________ _________________________________________ Name

Instructions: File as a separate document ECF Event: Bankruptcy>Notices>Notice of Fees and Costs-Mortgage