Free Local Form 15 - North Carolina

Local Form 15

July 2009

NOTICE OF PAYMENT AND/OR ESCROW CHANGE; NOTICE OF COST ADVANCE (to be filed with the Court) Debtor name: Creditor name: I. Escrow Payment Change New payment amt: $ Prior payment amt: $ Escrow change: Taxes $ Case No: Last 4 digits of loan # Date of Escrow Payment Change: Principal & interest: $ Principal & interest: $
(increase or decrease)

Escrow: $ Escrow $
(increase or decrease)

Insurance $
(increase or decrease)

Other: $

(Attach annual escrow analysis and basis for change with post-Chapter 13 added fees and costs for the last 12 months shown.)

II. Payment Change (adjustable interest rate): New payment amt: $ New interest rate: Interest index/rate: Margin +/- index: %

Date of Mortgage Payment Change: (principal & interest) Payment with escrow: $

% (former interest rate: $__________%) / %

III. Advances/Other Contractual Expenses: Advance Type: Paid to: Amount: $ /$ (Name) (Address) Creditor Contact: _________________________________________ _________________________________________ _________________________________________ _________________________________________ Mailing Address Contact person Tel #/Fax # E-mail address

CERTIFICATE OF SERVICE Service was provided by: First class mail on the day of Printed/typed name , . Signature and fax or e-mail