Secured Claim Worksheet (For secured claims, other than a mortgage claim) Case Name: ___________________________________________ Instructions: 1. Attach this Worksheet to the proof of claim, which should conform to Official Form 410. (This Worksheet is not to be used for claims secured by the debtor's principal residence. Use Official Form 410A for those claims.) Compute the claim as of the date on which the Debtor filed the petition initiating the case. Do NOT include interest or charges that accrue after the Petition Date (the date on which the petition initiating the case was filed) in the computation of the debt due on the Petition Date. A claim that accrues interest after the Petition Date for payments on secured debt not made when due after the petition date should be presented in a separate proof of claim dealing only with post-petition claims. Provide information on computation of claim as of Petition Date in the blanks below. Principal Balance and Accrued Interest MUST NOT include unearned interest. The completion and filing of this form does not prejudice a creditor's right to contest whether the creditor's interest in property of the estate is adequately protected by payments made post-petition. A B C D E Principal Balance Accrued Earned Interest As of Date of Filing Petition Late Charges Forced Placed Insurance Other Charges (itemize) $ $ $ F G H I J K Total Claim as of Petition Date (Sum of A-E) - Copy to Block 7 on Official Form 410 $ $ $ $ $ Case Number: _________________ 2. 3. 4. Amount necessary to cure any default as of the date of the $ petition Monthly Payment No. of Installments Past Due on Petition Date Contractual Annual Interest Rate (APR) Value of Collateral-Copy to Block 9 on Official Form 410 $ _______% $ American LegalNet, Inc. www.FormsWorkFlow.com