UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY Caption in Compliance with D.N.J. LBR 9004-1(b) In Re: Case No.: Chapter: Judge: ___________________ ___________________ ___________________ CREDITOR'S CERTIFICATION OF DEFAULT __________________________________________ certifies as follows: 1. I am a _______________________________ for _________________________ , a secured creditor of the debtor. 2. On ____________________________ , an Order was entered, a copy of which is attached as an exhibit, providing for the cure of post petition arrearages, and in default of such monthly payments for a 30 day period, allowing the secured creditor ex parte relief to vacate the stay, with notice to the trustee, debtor and his attorney, if any. 3. Debtor has failed to comply with the order: By missing payments and/or by failing to make the correct payments as summarized on the attached Certification of Creditor Regarding Post Petition Payment History. Other ________________________________________________________ . American LegalNet, Inc. www.FormsWorkFlow.com 4. This certification is being made in an effort to enforce the prior order of this court and to vacate the stay. 5. I certify under penalty of perjury that the above is true. Date: _______________________ ______________________________ Signature rev.8/1/15 2 American LegalNet, Inc. www.FormsWorkFlow.com