UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF WISCONSIN _____________________________________________________________________________________ : Chapter 13 In re: : : Case No: : : Debtor. _____________________________________________________________________________________ MEDIATOR’S FINAL REPORT _____________________________________________________________________________________ Name of Debtor’s Counsel: Name of Lender and Counsel: Property Address: Last Four Digits of Account Number of Loan: Mediation Session Date(s): How long from the Date of Appointment of Mediator to Date of Final Report: days The use of the Court’s Mortgage Modification Mediation Program has resulted in the following (please check appropriate box below): Loan Modification. Surrender of property. No agreement has been reached. Other: The filing of this Mediator’s Final Report terminates the Mortgage Modification Mediation with respect to the loan identified above by the last four digits of the account number. Dated: _____________________________________ Signature: __________________________________, Mediator American LegalNet, Inc. www.FormsWorkFlow.com