Attorney or Party Name, Address, Telephone & FAX Nos., State Bar No. & Email Address FOR COURT USE ONLY Attorney for Debtor(s) Debtor(s) appearing without an attorney **SELECT DIVISION** In re: _ CASE NO.: CHAPTER: **Select Chapter** No Hearing Required Debtor(s). 1. The Debtor requests that the court authorize the Mortgage Creditor, its successors in interest, its servicer, its beneficiary(ies) and/or its and their attorneys (Authorized Party) to establish contact and otherwise communicate with the Debtor and/or the Debtor’s attorney, if applicable, regarding the Debtor’s loan to explore the full range of solutions that may prevent either the loss of property to foreclosure, increased costs to the lender, or both. Potential solutions may include loan modification, loan refinance, forbearance, short sale, or surrender of the property in full satisfaction of the debt. Debtor asks the court to authorize direct communication between the Debtor, or the Debtor’s Attorney, if applicable, and the Authorized Party on the above-mentioned issues. The authorization requested will be valid notwithstanding the automatic stay provisions of 11 U.S.C. § 362(a), and the Authorized Party will not be held liable for violations of the stay for communication in furtherance of that purpose during Debtor’s case. 2. Property address: ______________________________________________________________________________ _____________________________________________________________________________________________ This form is optional. It has been approved for use in the United States Bankruptcy Court for the Central District of California. June 2011 Page 1 3. Name of Authorized Party with whom Debtor seeks to enter discussions: ________________________________________________________________ Authorized Party is: Mortgage Creditor Attorney for Mortgage Creditor Successor in interest Attorney for successor in interest Servicer Attorney for Servicer 4. Priority of lien: First trust deed Second trust deed Other (specify): ________________________________________________________ 5. (Check one box, if applicable): I am not represented by an attorney in this bankruptcy case. I am represented by an attorney in this bankruptcy case but have been unable to obtain my attorney’s consent to communicate with the Authorized Party listed above. I am represented by an attorney in this bankruptcy case, whose consent appears below. By: Date: Signature of Debtor Name: Printed Name of Debtor I am the attorney in this bankruptcy case. By my signature below I give my full and voluntary consent for the Debtor to communicate with the Authorized Party listed on this form in furtherance of the . My signature below does not confer my sanction of, or in any way obligate me to assist in, any or all agreements the Debtor may or may not reach with the respect to the Authorized Party. Date:___________________________ Signature:_______________________________________ (Debtor’s Attorney) Printed Name:____________________________________ This form is optional. It has been approved for use in the United States Bankruptcy Court for the Central District of California. June 2011 Page 2 I am over the age of 18 and not a party to this bankruptcy case or adversary proceeding. My business address is: A true and correct copy of the foregoing document described as chambers in the form and manner required by LBR 5005-2(d); and will be served or was served in the manner stated below: on the judge in : Pursuant to controlling General Order(s) and LBR, the foregoing document will be served by the court via NEF and hyperlink to the document. On ______________, I checked the CM/ECF docket for this bankruptcy case or adversary proceeding and determined that the following person(s) are on the Electronic Mail Notice List to receive NEF transmission at the email address(es) stated below: Service information continued on attached page (state method for each person or entity served): On ____________________, I served the following person(s) and/or entity(ies) at the last known address(es) in this bankruptcy case or adversary proceeding by placing a true and correct copy thereof in a sealed envelope in the United States mail, first class, postage prepaid, and/or with an overnight mail service addressed as follows. Listing the judge here constitutes a declaration that mailing to the judge will be completed no later than 24 hours after the document is filed. Service information continued on attached page (state method for each person or entity served): Pursuant to F.R.Civ.P. 5 and/or controlling LBR, on ___________________, I served the following person(s) and/or entity(ies) by personal delivery, or (for those who consented in writing to such service method), by facsimile transmission and/or email as follows. Listing the judge here constitutes a declaration that personal delivery on the judge will be completed no later than 24 hours after the document is filed. Service information continued on attached page I declare under penalty of perjury under the laws of the United States that the foregoing is true and correct. Date:___________________________ Signature:_______________________________________ Printed Name:____________________________________ This form is optional. It has been approved for use in the United States Bankruptcy Court for the Central District of California. June 2011 Page 3