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Foreclosure Application

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Foreclosure Application

Foreclosure Conciliation Program

Please fill out the form below to apply.

Personal Information

Name
Address
City/State/Zip
,
County
Home Phone
Work Phone
Employer
E-Mail
Date of Birth (MM/DD/YYYY)

Foreclosure Summons

Have you been served with a Foreclosure Summons?

Yes, I have been served with a Foreclosure Summons.
No, I have not been served with a Foreclosure Summons.

If yes, please enter the date you were served;
Docket/Case Number;
Who is the Plaintiff (Who is suing you)?

Did you receive a Notice to Homeowner when you were served informing you to call us?

Yes, I did receive a notice.
No, I did not receive a notice.

Have you filed an answer with the Clerk?

Yes, I have filed an answer with the Clerk.
No, I have not filed an answer with the Clerk.

Home Information

Do you claim a Homestead Exemption on this property?

Yes, I do claim a Homestead Exemption.
No, I do not claim a Homestead Exemption.

Do you currently live in the home?

Yes, I do currently live in the home.
No, I do not currently live in the home.

What is your monthly mortgage payment?
$ / Month

Does that payment include Taxes and Insurance?

Yes, Taxes and Insurance are included.
No, Taxes and Insurance are not included.

Do you have a second mortgage on the home?

Yes, I have a Second Mortgage.
No, I do not have a Second Mortgage.

Misc.

Do you have a particular hardship such as loss of job, illness, or hospitalization?

Yes, I have a particular hardship.
No, I do not a particular have hardship.

If yes, please specify;

Do you wish to try to save your home?

Yes, I want to save my home.
No, I do not want to save my home.

If not, why?

What is your monthly household income?
$ / Month

How many people live in your household?

Do you own any other homes or property?

Yes, I own another property.
No, I do not own another property.

Have you filed Bankruptcy?

Yes, I have filed bankruptcy.
No, I have not filed bankruptcy.

If yes, please specify;

Chapter 7
Chapter 13

Date of Filing;

Please Read and Sign Below

Signature

Date