Free form 15 - New Jersey

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UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY
Caption in Compliance with D.N.J. LBR 9004-2(c)

In Re:

Case No.: Chapter: Hearing Date: Judge:

__________________ __________________ __________________ __________________

CERTIFICATION RE CALCULATION OF AMOUNTS DUE NOTE AND MORTGAGE DATED _______________________

__________________________________ of full age, employed as _________________________________________ by _________________________________________, hereby certifies the following information: Recorded on _____________________, in _________________ County, in Book __________ at Page ___________ Property Address: _______________________________________________________________________________ Mortgage Holder: _______________________________________________________________________________

1. PAYOFF STATEMENT Unpaid Principal Balance ........................................................................................................... $ __________________ Interest from __________________ to __________________ ................................................. (Interest rate = _____% per year; $ ____________ per day x _________days) __________________

0.00 Late Charges from ___________ to __________ ($ ______________/mo. x ______ mos.) .... ___________________
Attorney's fees and costs as of ___________________________ ........................................... ___________________

Advances through __________________________ for: Real Estate Taxes .................................... $ ______________ Insurance premiums ................................ M.I.P. ...................................................... Inspections .............................................. Winterizing/Securing .............................. ______________ ______________ ______________ ______________

Sub-Total of Advances ........................... $ ______________ Less Escrow Monies ............................... (_____________) $ __________________ 0.00

0.00 Net Advances .......................................... $ ______________

Interest on advances from ____________ to ________________ ........................................... __________________ Other charges (specify) ................................................................................................................ __________________ Less unearned interest .................................................................................................................. (_________________)

0.00 TOTAL DUE AS OF ____/____/____ ............................................................ $ _________________

II. EQUITY ANALYSIS (When appropriate) Estimated fair market value of real estate (as of _______________________) .......................... $ __________________* Liens on the real estate: 1. Real estate taxes as of ___________________ ............................. $______________ 2. First Mortgage (principal and interest), as of ________________ $ _____________ 3. Second Mortgage (principal and interest), as of ______________ $ _____________ 4. Other (specify on separate exhibit) .................................................. $ _____________

0.00 TOTAL LIENS ...................................................................... ($ _____________) $ (______________) 0.00
APPARENT EQUITY AS OF ___/___/___ ................................................... $ _________________** 0.00

*Source: _____________________________ (e.g. appraisal, tax bill/assessment, contract of sale, debtor's schedules, etc.) ** If negative, insert zero (0).

I certify under penalty of perjury that the foregoing is true and correct. ________________________________ (Date of signature) ________________________________ Signature

Local Form 15, rev.8/1/06.jml