R.I. Local Form 3002-1.1 UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF RHODE ISLAND - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - * In re: : : BK No. Debtor(s) : Chapter : - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - * CERTIFICATION OF SUPPLEMENTAL PROOF OF CLAIM DOCUMENT(S) I , hereby certify under penalty of perjury as follows: is the holder of a claim that is secured by a security interest in the debtor222s principle residence; A proof of claim was timely filed pursuant to Fed. R. Bankr. P. 3002 (hereinafter 223Bankruptcy Rule224) together with the attachments required by Bankruptcy Rule 3001(c)(2)(C), which claim number is ; The within attachment(s) are required by Bankruptcy Rule 3001(c)(1) and (d) and are being filed pursuant to Bankruptcy Rule 3002(c)(7) as a supplement to the holder222s proof of claim. The within attachment (s) required by Bankruptcy Rule 3001(c)(1) and (d) are being filed no later than 120 days after the order for relief was entered, or within the time allowed by any previously granted extension of time. Check the appropriate. I am the creditor. I am the creditor222s authorized agent. I declare under penalty of perjury that the information provided is true and correct. Signature Date Print: First Name Middle Name Last Name Company: Address: American LegalNet, Inc. www.FormsWorkFlow.com