Attorney or Party Name, Address, Telephone & FAX Nos., State Bar No. & Email Address FOR COURT USE ONLY Debtor(s) appearing without an attorney Attorney for Debtor(s) UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA ­ **SELECT DIVISION** **SELECT DIVISION** In re: CASE NO.: CHAPTER: 13 DIVISION DECLARATION SETTING FORTH POSTPETITION, PRECONFIRMATION PAYMENTS ON: 1) DEEDS OF TRUST [OR MORTGAGES] 2) LEASES ON PERSONAL PROPERTY 3) PURCHASE MONEY SECURITY LIENS ON PERSONAL PROPERTY [LBR 3015-1(e) and LBR 3015-1(m)] [No Hearing Required] Debtor(s). I, (Debtor's name) 1. I am the debtor in this chapter 13 bankruptcy case that was filed on: . , hereby declare: 2. On the next page I have listed all the payments I have made to secured creditors and lessors since the filing of my chapter 13 petition. 3. I have provided the name of the secured creditor and/or lessor and the type of obligation to that secured creditor and/or lessor. 4. I understand that I must update the information on the next page and keep it current until my plan is confirmed. This form is mandatory. It has been approved for use by the United States Bankruptcy Court for the Central District of California. June 2012 Page 1 F 3015-1.4.DEC.PRECONF.PYMTS 5. The following are the postpetition payments up to the date of plan confirmation (Payments) that I have caused to be mailed/delivered to the appropriate creditors (Creditor)1: Property Description Creditor/Type of loan Name of Creditor (printed): __________________________ __________________________ (check one): Deed of Trust/Mortgage Car loan Lease Other (specify):_________ _________________________ Name of Creditor (printed): __________________________ __________________________ (check one) Deed of Trust/Mortgage Car loan Lease Other (specify):_________ _________________________ Name of Creditor (printed): __________________________ __________________________ (check one) Deed of Trust/Mortgage Car loan Lease Other (specify):_________ _________________________ Name of Creditor (printed): __________________________ __________________________ (check one) Deed of Trust/Mortgage Car loan Lease Other (specify):_________ _________________________ Payment Amount Due Date2 Date Mailed/ Delivered 1 2 Attach additional pages if necessary "Due Date" refers to the 1st day the Payment is due. This form is mandatory. It has been approved for use by the United States Bankruptcy Court for the Central District of California. June 2012 Page 2 F 3015-1.4.DEC.PRECONF.PYMTS Property Description Creditor/Type of loan Name of Creditor (printed): __________________________ __________________________ (check one): Deed of Trust/Mortgage Car loan Lease Other (specify):_________ _________________________ Name of Creditor (printed): __________________________ __________________________ (check one) Deed of Trust/Mortgage Car loan Lease Other (specify):_________ _________________________ Name of Creditor (printed): __________________________ __________________________ (check one) Deed of Trust/Mortgage Car loan Lease Other (specify):_________ _________________________ Payment Amount Due Date 3 Date Mailed/ Delivered 6. Continued on Attached Page. 7. I declare under penalty of perjury under the laws of the United States that the foregoing is true and correct. Date: By: Signature of Debtor Printed Name of Debtor 3 "Due Date" refers to the 1st day the Payment is due. This form is mandatory. It has been approved for use by the United States Bankruptcy Court for the Central District of California. June 2012 Page 3 F 3015-1.4.DEC.PRECONF.PYMTS PROOF OF SERVICE OF DOCUMENT 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 entitled: DECLARATION SETTING FORTH POSTPETITION, PRECONFIRMATION PAYMENTS ON: 1) DEEDS OF TRUST [OR MORTGAGES], 2) LEASES ON PERSONAL PROPERTY, 3) PURCHASE MONEY SECURITY LIENS IN PERSONAL PROPERTY [LBR 3015-1(e) and LBR 30151(m)] will be served or was served (a) on the judge in chambers in the form and manner required by LBR 5005-2(d); and (b) in the manner stated below: 1. TO BE SERVED BY THE COURT VIA NOTICE OF ELECTRONIC FILING (NEF): Pursuant to controlling General Orders and LBR, the foregoing document will be served by the court via NEF and hyperlink to the document. On (date) _______________, I checked the CM/ECF docket for this bankruptcy case or adversary proceeding and determined that the following persons are on the Electronic Mail Notice List to receive NEF transmission at the email addresses stated below: Service information continued on attached page 2. SERVED BY UNITED STATES MAIL: On (date) _______________, I served the following persons and/or entities at the last known addresses 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 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 3. SERVED BY PERSONAL DELIVERY, OVERNIGHT MAIL, FACSIMILE TRANSMISSION OR EMAIL (state method for each person or entity served): Pursuant to F.R.Civ.P. 5 and/or controlling LBR, on (date) _______________, I served the following persons and/or entities by personal delivery, overnight mail service, 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, or overnight mail to, 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 Printed Name Signature This form is mandatory. It has been approved for use by the United States Bankruptcy Court for the Central District of California. June 2012 Page 4 F 3015-1.4.DEC.PRECONF.PYMTS