Free Mediation Request Statement - New Jersey

FORECLOSURE MEDIATION INSTRUCTIONS
(FOR HOMEOWNERS SEEKING A STAY OF A SHERIFF'S SALE AND MEDIATION)
DOCKET NO:

F

­

Court-sponsored foreclosure mediation is limited to homeowners whose principal residence (1 to 3 family) is the subject of a foreclosure action. The homeowner must be the borrower. Call the toll free telephone number 888-989-5277 and ask for the name of a housing counselor in your area who is certified by the Department of Housing & Urban Development (HUD) and the New Jersey Housing and Mortgage Finance Agency (NJHMFA). Make an immediate appointment to meet with the HUD/NJHMFAcertified housing counselor who will discuss your financial situation, help you fill out the attached Foreclosure Mediation Financial Worksheet, offer potential options and help you apply for court-sponsored foreclosure mediation. The Foreclosure Mediation Financial Worksheet and Mediation Request Form must be returned by the DATE SET FORTH IN THE ORDER STAYING THE SHERIFF'S SALE TO THE PERSON NAMED BELOW AT THE ADDRESS SPECIFIED BELOW. The HUD/NJMFA-certified housing counselor must return the ORIGINAL and TWO COPIES of the Mediation Request Statement and the ORIGINAL and TWO COPIES of the Mortgage Foreclosure Financial Worksheet with THREE COPIES of all required attachments affixed to the worksheets to:

- FOR COURT USE ONLY ­ Insert Vicinage CDR Point Person's name and address or Judge's name and chamber's address

Acknowledgment of Receipt of Notice of Mediation On the _____ day of __________________________, 20___. I/we acknowledge receipt of a copy of this foreclosure mediation instruction. Homeowner's Signature _________________________ Homeowner's Signature _________________________
Print Name: Print Name:

Revised 6/22/2009, CN 11275 -English, (Mediation Request Instructions ­ Sheriff Sale Stay)

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Print Form

Clear Form

MEDIATION REQUEST STATEMENT

DOCKET NO: F
Plaintiff's Name

­

v. MEDIATION REQUESTED

First Defendant's Name

SECTION A

Homeowner-Borrower(s) request court sponsored foreclosure mediation.

HOMEOWNER-BORROWER'S CERTIFICATION
hereby certifies and says:
[insert your name(s)]

1. I / We am/are the owner and mortgagor of the property subject to foreclosure in the above captioned foreclosure action, which property is known as
[insert the property address]

, New Jersey.

2. I / We am/are the borrowers on the mortgage loan. 3. I / We live in the above-described property and the property is my/our principal residence. 4. I / We have have not filed an answer to the foreclosure complaint filed by my lender.

I / We certify that the statements made above are true. I / We am / are aware that if any of the statements made by me / us are willfully false, I / we am / are subject to punishment.
Signature Date Signature Date

(Type or Print Name)

(Type or Print Name)

HOMEOWNER'S FORECLOSURE PREVENTION PROPOSAL
Briefly outline the workout proposal you are seeking (if necessary, attach additional pages):

If known, the lender's loss mitigation representative's name and his/her location and telephone number is:

HOMEOWNER CONTACT INFORMATION
Name Address Home Telephone Cell Phone

Revised 6/22/2009, CN 11275 -English, (Mediation Request Instructions ­ Sheriff Sale Stay)

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