Revised 02/7/2018, CN 11655 Foreclosure Mediation Checklist Submission Date s DOCKET NO: F 226 Borrower and Co - Borrower Information Borrower222s Name Co-Borrower222s Name Subject Property Address Street Address City State Zip Code Lender Foreclosure Mediation Documents - Write the loan number on the top of every page. Mediation Request Statement - signed and dated. ( njcourts.gov/forms/11270hudnjhmfaborrowerinstruct.pdf) Hardship letter - signed and dated. Request for Mortgage Assistance Form (fill out carefully) - signed and dated. Contact the lender or lender222s attorney, by phone or by visiting and reviewing the lender222s website to obtain this form. Dodd Frank Certification - signed and dated. Contact the lender or lender222s attorney , by phone or by visiting and reviewing the lender222s website to obtain this form. Paystubs for each wage earner totaling one current month of income. List of recurring monthly expenses - signed and dated. Copies of all W-2222s, for the last 2 years. Federal Tax Returns for the last 2 years (include all pages and schedules) - signed and dated. Provide copies of all bank statements and all accounts, for the last 2 months. Make sure to include all pages, even if they are blank. (Remember to write the loan number on EVERY page.) Tax Form 4506-T or 4506T-EZ - signed and dated. To access this form go to www.irs.gov and select the 223Forms & Instructions224 tab, then select 223Form 4506-T224 under 223Popular Forms, Instructions & Publications.224 Provide a copy of your most recent Gas and Electric bill; verifying that the home is the primary address. If you or anyone in your household receives social security, pension income, or disability of any kind, provide a copy of the most recent award letter(s), and circle the direct deposit of these funds into your bank account on your statements. If you receive alimony and/or child support, please provide a copy of your div orce/separation decree and a copy of the court order with the amount of your child support and/or alimony. If the funds are directly deposited into a bank account, please circle these deposits on the statements. Rental income must be documented with a rental agreement - signed and dated. Rental income must be circled on bank statements appearing as deposits on a monthly basis (cash rental receipts are not acceptable). If someone else in your household, who is not on the mortgage, contributes financially to the household please provide a letter stating how much this person contributes to the household each month. Each of you must sign and date the letter (this may include your spouse). Self - Employed Borrowers - In ad dition to items listed above, please submit the following: Year to date Profit and Loss statement. Provide c opies of all bank statements and business accounts for the last 4 months . Make sure to include all pages, even if they are blank. American LegalNet, Inc. www.FormsWorkFlow.com