UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY Caption in Compliance with D.N.J. LBR 9004-2(c) In Re: Case No.: __________________ Chapter: __________________ Hearing Date: __________________ Judge: __________________ CERTIFICATION RE CALCULATION OF AMOUNTS DUE NOTE AND MORTGAGE DATED _______________________ __________________________________ of full age, employed as _________________________________________ by _________________________________________, hereby certifies the following information: Recorded on _____________________, in _________________ County, in Book __________ at Page ___________ Property Address: _______________________________________________________________________________ Mortgage Holder: _______________________________________________________________________________ 1. PAYOFF STATEMENT Unpaid Principal Balance ........................................................................................................... $ __________________ Interest from __________________ to __________________ ................................................. __________________ (Interest rate = _____% per year; $ ____________ per day x _________days) Late Charges from ___________ to __________ ($ ______________/mo. x ______ mos.) .... ___________________ Attorney’s fees and costs as of ___________________________ ........................................... ___________________ American LegalNet, Inc. www.FormsWorkflow.com Advances through __________________________ for: Real Estate Taxes .................................... $ ______________ Insurance premiums ................................ ______________ M.I.P. ...................................................... ______________ Inspections .............................................. ______________ Winterizing/Securing .............................. ______________ Sub-Total of Advances ........................... $ ______________ Less Escrow Monies ............................... (_____________) Net Advances .......................................... $ ______________ $ __________________ Interest on advances from ____________ to ________________ ........................................... __________________ Other charges (specify) ................................................................................................................ __________________ Less unearned interest .................................................................................................................. (_________________) TOTAL DUE AS OF ____/____/____ ............................................................ $ _________________ II. EQUITY ANALYSIS (When appropriate) Estimated fair market value of real estate (as of _______________________) .......................... $ __________________* Liens on the real estate: 1. Real estate taxes as of ___________________ ............................. $______________ 2. First Mortgage (principal and interest), as of ________________ $ _____________ 3. Second Mortgage (principal and interest), as of ______________ $ _____________ 4. Other (specify on separate exhibit) .................................................. $ _____________ TOTAL LIENS ...................................................................... ($ _____________) $ (______________) APPARENT EQUITY AS OF ___/___/___ ................................................... $ _________________** *Source: _____________________________ (e.g. appraisal, tax bill/assessment, contract of sale, debtor’s schedules, etc.) ** If negative, insert zero (0). I certify under penalty of perjury that the foregoing is true and correct. ________________________________ (Date of signature) ________________________________ Signature Local Form 15, rev.8/1/06.jml American LegalNet, Inc. www.FormsWorkflow.com