Fill in this information to identify the case: B 10 (Supplement 2) (12/11) Debtor 1 Debtor 2 (Spouse, if filing) (post publication draft) __________________________________________________________________ ________________________________________________________________ United States Bankruptcy Court for the: ______________________ District of __________ (State) Case number ___________________________________________ Official Form 410S2 Notice of Postpetition Mortgage Fees, Expenses, and Charges 12/16 If the debtor's plan provides for payment of postpetition contractual installments on your claim secured by a security interest in the debtor's principal residence, you must use this form to give notice of any fees, expenses, and charges incurred after the bankruptcy filing that you assert are recoverable against the debtor or against the debtor's principal residence. File this form as a supplement to your proof of claim. See Bankruptcy Rule 3002.1. Name of creditor: _______________________________________ Last 4 digits of any number you use to identify the debtor's account: Court claim no. (if known): __________________ ____ ____ ____ ____ Does this notice supplement a prior notice of postpetition fees, expenses, and charges? No Yes. Date of the last notice: ____/____/_____ Itemize Postpetition Fees, Expenses, and Charges Part 1: Itemize the fees, expenses, and charges incurred on the debtor's mortgage account after the petition was filed. Do not include any escrow account disbursements or any amounts previously itemized in a notice filed in this case. If the court has previously approved an amount, indicate that approval in parentheses after the date the amount was incurred. Description 1. Late charges 2. Non-sufficient funds (NSF) fees 3. Attorney fees 4. Filing fees and court costs 5. Bankruptcy/Proof of claim fees 6. Appraisal/Broker's price opinion fees 7. Property inspection fees 8. Tax advances (non-escrow) 9. Insurance advances (non-escrow) 10. Property preservation expenses. Specify:_______________ 11. Other. Specify:____________________________________ 12. Other. Specify:____________________________________ 13. Other. Specify:____________________________________ 14. Other. Specify:____________________________________ Dates incurred Amount (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ $ __________ The debtor or trustee may challenge whether the fees, expenses, and charges you listed are required to be paid. See 11 U.S.C. § 1322(b)(5) and Bankruptcy Rule 3002.1. Official Form 410S2 Notice of Postpetition Mortgage Fees, Expenses, and Charges American LegalNet, Inc. www.FormsWorkFlow.com page 1 Debtor 1 _______________________________________________________ First Name Middle Name Last Name Case number (if known) _____________________________________ Part 2: Sign Here The person completing this Notice must sign it. Sign and print your name and your title, if any, and state your address and telephone number. Check the appropriate box. I am the creditor. I am the creditor's authorized agent. I declare under penalty of perjury that the information provided in this claim is true and correct to the best of my knowledge, information, and reasonable belief. __________________________________________________ Signature Date ____/_____/________ Print: _________________________________________________________ First Name Middle Name Last Name Title ___________________________ Company _________________________________________________________ Address _________________________________________________________ Number City Street State ZIP Code ___________________________________________________ Contact phone (______) _____­ _________ Email ________________________ Official Form 410S2 Notice of Postpetition Mortgage Fees, Expenses, and Charges American LegalNet, Inc. www.FormsWorkFlow.com page 2