UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY Caption in Compliance with D.N.J. LBR 9004-2(c) In Re: Case No.: Judge: Chapter: ________________ ________________ ________________ APPLICATION FOR EXTENSION OR EARLY TERMINATION OF LOSS MITIGATION PERIOD The undersigned is the _________________________________________ in this matter. On ____________________, a Loss Mitigation Order was entered concerning: Property: Creditor: ___________________________________________________________ ___________________________________________________________ Pursuant to the Loss Mitigation Order, the Loss Mitigation Period will expire on ____________________. For the reason(s) set forth below, the _______________________ hereby requests: An extension of the Loss Mitigation Period to _____________________ . Early termination of the Loss Mitigation Period, effective _____________________ . Set forth the applicant's reason(s) for the above request: Dated: ___________________ _________________________________ Applicant's signature Revised 9/19/13 American LegalNet, Inc. www.FormsWorkFlow.com