UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF FLORIDA www.flsb.uscourts.gov In re: Case No. Chapter Debtor(s) / THIRD PARTY'S CONSENT TO ATTEND AND PARTICIPATE IN MORTGAGE MODIFICATION MEDIATION The undersigned, ______________________________, consents to participate in Mortgage Modification Mediation ("MMM") and attend all MMM conferences for property located at 1. I am not a Debtor in this case. 2. I am: a. b. c. d. the Debtor's non-filing spouse a co-obligor on the promissory note a co-borrower on the mortgage other/third party: _______________________________________________ as follows: 3. I am willing to enter into a binding settlement agreement with the Lender, but understand I am not required to do so. 4. I am willing to provide Debtor's attorney, or if the Debtor is not represented, the Debtor, with all documents required for MMM upon request. 5. I have not entered into a written legal representation agreement with Debtor's attorney, and acknowledge that I am not represented by Debtor's attorney for MMM Page 1 of 2 MMM-LF-10 (08/01/14) American LegalNet, Inc. www.FormsWorkFlow.com or any other matter, if the Debtor is represented by an attorney. 6. I understand I am entitled to retain my own attorney to represent me in this matter if I so choose. 7. I understand all communication and information exchanged during MMM is confidential. Dated: ____________________ By: _________________________________ Print Name:___________________________ Address:_____________________________ Telephone:___________________________ Fax:_________________________________ email:_______________________________ STATE OF FLORIDA COUNTY OF SWORN AND SUBSCRIBED before me this _____ day of [date____________, 20___,] by [Party____________________________, who is personally known to me or who has produced _____________________ as identification. ______________________________ Notary Public, State of Florida Commission No. My Commission Expires: Page 2 of 2 MMM-LF-10 (08/01/14) American LegalNet, Inc. www.FormsWorkFlow.com