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VTB MM Form # 12 04/2018 See Vt. LBR 4001-7(d) UNITED STATES BANKRUPTCY COURT DISTRICT OF VERMONT In re: , Chapter Debtor(s). Case # REPORT OF MEDIATION INTERIM / FINAL Name of lender: Date mortgage executed: Last four digits of loan number: Current loan balance: Property address: Date mediator appointed: Mediator: Mediation completed? (if so, date?) 1. Date of mediator first contact with parties: 2. Date[s] of pre-mediation conference[s]: Name and role of each participant: 3. Date[s] of mediation session[s]: Name and role of each participant: 4. At each mediation event, all parties did / did not participate in good faith. If not, explain: 5. Interim Report: Status of mediation: Anticipated completion date: Explanation of why mediation is not completed: A. To advance the mediation, the mediator, on behalf of all parties, requests a status hearing or in-chambers conference [select one] within days; OR B. The status hearing scheduled for is not needed and the mediator and parties request the status hearing be cancelled or postponed for days (select one) because: the mediator and parties have agreed as follows: the mediator has scheduled the following event[s]: ; OR C. The mediator recommends the following alternative course of action: . 6. Final Report: The use of mediation has resulted in the following: Loan modification Reinstatement Short sale Forbearance Surrender of property If other agreement, describe: No agreement 7. Court action requested: 8. Other information pertinent to the status or conduct of the mediation: . Dated: By: [Signature] [typed name, with address, e-mail address, and telephone number] American LegalNet, Inc. www.FormsWorkFlow.com