Fill in this information to identify the case: B 10 (Supplement 2) (12/11) Debtor 1 Debtor 2 (Spouse, if filing) (post publication draft) __________________________________________________________________ ________________________________________________________________ United States Bankruptcy Court for the: ______________________ District of __________ (State) Case number ___________________________________________ Form 4100R Response to Notice of Final Cure Payment According to Bankruptcy Rule 3002.1(g), the creditor responds to the trustee's notice of final cure payment. 10/15 Part 1: Mortgage Information Name of creditor: ______________________________________ ____ ____ ____ ____ Court claim no. (if known): _________________ Last 4 digits of any number you use to identify the debtor's account: Property address: ________________________________________________ Number Street _______________________________________________ ________________________________________________ City State ZIP Code Part 2: Prepetition Default Payments Check one: Creditor agrees that the debtor(s) have paid in full the amount required to cure the prepetition default on the creditor's claim. Creditor disagrees that the debtor(s) have paid in full the amount required to cure the prepetition default on the creditor's claim. Creditor asserts that the total prepetition amount remaining unpaid as of the date of this response is: Postpetition Mortgage Payment $ __________ Part 3: Check one: Creditor states that the debtor(s) are current with all postpetition payments consistent with § 1322(b)(5) of the Bankruptcy Code, including all fees, charges, expenses, escrow, and costs. The next postpetition payment from the debtor(s) is due on: ____/_____/______ MM / DD / YYYY Creditor states that the debtor(s) are not current on all postpetition payments consistent with § 1322(b)(5) of the Bankruptcy Code, including all fees, charges, expenses, escrow, and costs. Creditor asserts that the total amount remaining unpaid as of the date of this response is: a. Total postpetition ongoing payments due: b. Total fees, charges, expenses, escrow, and costs outstanding: c. Total. Add lines a and b. (a) $ __________ $ __________ $ __________ + (b) (c) Creditor asserts that the debtor(s) are contractually obligated for the postpetition payment(s) that first became due on: Form 4100R ____/_____/______ MM / DD / YYYY Response to Notice of Final Cure Payment page 1 American LegalNet, Inc. www.FormsWorkFlow.com Debtor 1 _______________________________________________________ First Name Middle Name Last Name Case number (if known) _____________________________________ Part 4: Itemized Payment History If the creditor disagrees in Part 2 that the prepetition arrearage has been paid in full or states in Part 3 that the debtor(s) are not current with all postpetition payments, including all fees, charges, expenses, escrow, and costs, the creditor must attach an itemized payment history disclosing the following amounts from the date of the bankruptcy filing through the date of this response: all payments received; all fees, costs, escrow, and expenses assessed to the mortgage; and all amounts the creditor contends remain unpaid. Part 5: Sign Here The person completing this response must sign it. The response must be filed as a supplement to the creditor's proof of claim. Check the appropriate box:: I am the creditor. I am the creditor's authorized agent. I declare under penalty of perjury that the information provided in this response is true and correct to the best of my knowledge, information, and reasonable belief. 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 response applies. __________________________________________________ Signature Date ____/_____/________ Print _________________________________________________________ First Name Middle Name Last Name Title ___________________________________ Company _________________________________________________________ If different from the notice address listed on the proof of claim to which this response applies: Address _________________________________________________________ Number Street ___________________________________________________ City State ZIP Code Contact phone (______) _____­ _________ Email ________________________ Form 4100R Response to Notice of Final Cure Payment page 2 American LegalNet, Inc. www.FormsWorkFlow.com