UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF FLORIDA www.flsb.uscourts.gov In re: Case No. Chapter Debtor(s) / DEBTOR'S NOTICE OF SELECTION OF MORTGAGE MODIFICATION MEDIATOR Pursuant to the Mortgage Modification Mediation (MMM) procedures adopted under Administrative Order 14-03, this Notice is filed by the Debtor to notify the court on the status of the selection of mediator in the above referenced case. 1. The parties agree to and select the following Mediator: ________________________________________________ Name of Mediator ________________________________________________ COMPANY ________________________________________________ City, State, Zip Code ________________________________________________ Telephone email:___________________________________________ 2. The Lender, __________________________, failed to contact the Debtor within the time prescribed in the order of referral, and has therefore waived the right to participate in the mediator selection process. The Debtor has selected the following Mediator: ________________________________________________ Name of Mediator ________________________________________________ COMPANY ________________________________________________ City, State, Zip Code ________________________________________________ Telephone email:___________________________________________ MMM-LF-11 (08/01/14) American LegalNet, Inc. www.FormsWorkFlow.com 3. The parties have conferred but are unable to agree upon the selection of a mediator, and Debtor requests that the clerk select a mediator from the clerk's Mediation Register. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the Notice of Selection of Mortgage Modification Mediator was served by U.S. first class mail upon the parties listed below on ______________________, 20____. /s/___________________________________ Self-Represented Debtor Attorney for Debtor _____________________________________ Address _____________________________________ Telephone _____________________________________ Fax _____________________________________ Florida Bar No. (if applicable) _____________________________________ email Copies to: [Debtor] Lender (identify name of Lender and where notice sent) [Attorney for Lender] Any Co-borrower The Mediator (notice sent to email address only) MMM-LF-11 (08/01/14) American LegalNet, Inc. www.FormsWorkFlow.com