B 10 (Supplement 2) (12/11) UNITED STATES BANKRUPTCY COURT __________ District of __________ In re ___________________________________, Case No. _______________________ Debtor Chapter 13 Notice of Postpetition Mortgage Fees, Expenses, and Charges If you hold a claim secured by a security interest in the debtor's principal residence, you must use this form to give notice of any postpetition fees, expenses, and charges that you assert are recoverable against the debtor or against the debtor's principal residence. File this form as a supplement to your proof of claim. See Bankruptcy Rule 3002.1. Name of creditor: _______________________________________ Last four digits of any number you use to identify the debtor’s account: Court claim no. (if known): __________________ ____ ____ ____ ____ Does this notice supplement a prior notice of postpetition fees, expenses, and charges?   No Yes. Date of the last notice: ____/____/_____ Part 1: Itemize Postpetition Fees, Expenses, and Charges Itemize the fees, expenses, and charges incurred on the debtor’s mortgage account after the petition was filed. Do not include any escrow account disbursements or any amounts previously itemized in a notice filed in this case or ruled on by the bankruptcy court. Description Dates incurred Amount 1. Late charges _________________________________ (1) $ __________ 2. Non-sufficient funds (NSF) fees _________________________________ (2) $ __________ 3. Attorney fees _________________________________ (3) $ __________ 4. Filing fees and court costs _________________________________ (4) $ __________ 5. Bankruptcy/Proof of claim fees _________________________________ (5) $ __________ 6. Appraisal/Broker’s price opinion fees _________________________________ (6) $ __________ 7. Property inspection fees _________________________________ (7) $ __________ 8. Tax advances (non-escrow) _________________________________ (8) $ __________ 9. Insurance advances (non-escrow) _________________________________ (9) $ __________ 10. Property preservation expenses. Specify:_______________ _________________________________ (10) $ __________ 11. Other. Specify:____________________________________ _________________________________ (11) $ __________ 12. Other. Specify:____________________________________ _________________________________ (12) $ __________ 13. Other. Specify:____________________________________ _________________________________ (13) $ __________ 14. Other. Specify:____________________________________ _________________________________ (14) $ __________ The debtor or trustee may challenge whether the fees, expenses, and charges you listed are required to be paid. See 11 U.S.C. § 1322(b)(5) and Bankruptcy Rule 3002.1. American LegalNet, Inc. www.FormsWorkFlow.com B 10 (Supplement 2) (12/11) Page 2 Part 2: Sign Here The person completing this Notice must sign it. Sign and print your name and your title, if any, and state your address and telephone number if different from the notice address listed on the proof of claim to which this Supplement applies. Check the appropriate box. ❐ I am the creditor. ❐ I am the creditor’s authorized agent. (Attach copy of power of attorney, if any.) I declare under penalty of perjury that the information provided in this Notice is true and correct to the best of my knowledge, information, and reasonable belief.  _____________________________________________________________ Date ____/_____/________ Title ___________________________ Signature Print: _________________________________________________________ First Name Middle Name Last Name Company _________________________________________________________ Address _________________________________________________________ Number Street ___________________________________________________ City Contact phone (______) _____– _________ State ZIP Code Email ________________________ American LegalNet, Inc. www.FormsWorkFlow.com