Testing of Model Bankruptcy Periodic Forms for Mortgage Servicing

Generic Clearance for Development and/or Testing of Model Forms, Disclosures, Tools, and Other Similar Related Materials

Appendix H-30(E) (proposed)

Testing of Model Bankruptcy Periodic Forms for Mortgage Servicing

OMB: 3170-0022

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Springside Mortgage

Customer Service: 1-800-555-1234

www.springsidemortgage.com

Mortgage Statement

Statement Date: 3/20/2015

$351,569.29



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Account Information

Outstanding Principal

$264,776.43

Interest Rate (Until October 2015)

4.75%

Prepayment Penalty

Yes


Our records reflect that you are presently a debtor in an active bankruptcy case or you previously received a discharge in bankruptcy. This statement is being sent to you for informational and compliance purposes only. It should not be construed as an attempt to collect a debt against you personally.

Explanation of Payment Amount

Principal

$386.46

Interest

$1,048.07

Escrow (Taxes and Insurance)

$235.18

Regular Monthly Payment

$1,669.71

Total Fees and Charges

$410.00

Unpaid past payments

$2,259.42

Total Payment Amount

$4,339.13



Bankruptcy Notice

Account Number

1234567

Payment Date

4/1/2015

Payment Amount

$4,339.13




Payment Amount

Payment Date:

Payment Amount:

4/1/2015

$4,339.13

Additional Principal

$ .

Additional Escrow

$ .

Total Amount Enclosed

$ .


If you are currently a party in a bankruptcy case and you choose to make a voluntary payment, detach and return bottom remittance portion with your payment. Make any checks payable to Springside Mortgage.

Transaction Activity (2/20 to 3/19)

Date

Description

Charges

Payments

3/13/15

Partial Payment Received*


$1,000.00

3/16/15

Late Fee (charged because full payment not received by 3/15/2015)

$160.00


3/19/15

Property Inspection Fee

$250.00



Past Payments Breakdown


Paid Last Month

Paid Year to Date

Principal

$0.00

$383.31

Interest

$0.00

$1,051.22

Escrow (Taxes and Insurance)

$0.00

$235.18

Fees

$0.00

$410.00

Partial Payment (Unapplied)*

$1,000.00

$1,490.00

Total

$1,000.00

$3,569.71



Important Messages

*Partial Payments: Any partial payments that you make are not applied to your mortgage, but instead are held in a separate suspense account. If you pay the balance of a partial payment, the funds will then be applied to your mortgage.



**Account History**

Recent Account History

  • Payment due 12/1/14: Fully paid on time

  • Payment due 1/1/15: Fully paid on 2/3/15

  • Payment due 2/1/15: Unpaid balance of $589.71

  • Payment due 3/1/15: Unpaid balance of $2,079.71

  • Current payment date 4/1/15: $1,669.71

  • Total: $4,339.13 unpaid amounts.


If You Are Experiencing Financial Difficulty: See back for information about mortgage counseling or assistance.



Jordan and Dana Smith

4700 Jones Drive

Memphis, TN 38109



1234567 34571892 342359127 DN

Springside Mortgage

P.O. Box 11111

Los Angeles, CA 90010


Springside Mortgage



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