LOCAL FORM 4001-1 UNITED STATES BANKRUPTCY COURT DISTRICT OF MINNESOTA In re: Debtors. LOAN HISTORY Begin loan history from the date of the first default related to the current default amount that is claimed in the motion. Case No. CHARGES Date Amount Rec'd From Debtor(s) Monthly Amount Due Principal/Interest Monthly Amount Due Escrow Amount Due Late Fees Amount Due Other Charge* Description of Other Charge TOTALS: $ $ $ $ $ (a) (b) (c) (d) (e) * Any "Other Charge" must be described, itemized by amount and allowed under note and/or mortgage (e.g., inspection fee, appraisal fee, insurance, taxes, etc.). Note: Columns (b) + (c) + (d) + (e) - (a) must equal the current default amount that is claimed in the motion. Attorneys fees and filing fee for the motion, if allowed under note and/or mortgage and sought by movant to resolve motion. Current default amount claimed in the motion. Escrow balance (amounts held for payment of taxes, insurance, etc.) Suspense account balance (amount of un-applied payments). $ $ $ $ American LegalNet, Inc. www.FormsWorkFlow.com