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STATE OF NEVADA FORECLOSURE MEDIATION PROGRAM ELECTION/WAIVER OF MEDIATION FORM
(To be filled out by Trustee)

PROPERTY ADDRESS ___________________________ _______________________________________________ TRUSTEE ______________________________________

TS # ___________________________________________ APN ___________________________________________ DoT __________ Book/Inst _______________________

***ATTENTION--YOU MUST ACT WITHIN THIRTY (30) DAYS*** IF NO ACTION IS TAKEN, THE FORECLOSURE MAY PROCEED
You have been served with a Notice of Default and Election to Sell, a copy of which is enclosed, that could result in the loss of your home. You may want to consult with an attorney concerning your rights and responsibilities. The State of Nevada has created a mediation program for homeowners whose owner occupied, primary residence is subject to foreclosure. Mediation is a process through which you and the lender meet with a neutral mediator to determine whether an agreement can be reached to cure any defaults in the loan or modify the terms of the loan to enable you to remain in your home. The mediator will be appointed by the Foreclosure Mediation Program Administrator. The mediator will not provide legal advice to either party. If you feel the need for legal representation, it is recommended that you retain an attorney to assist you in the mediation.
Your Name(s): ___________________________ Address: ________________________________ ________________________________________ Phone No: ( ) _________________ (telephone) ( ) _________________ (cellular) Email: __________________________________ Co-owner's Name: ________________________ Address: ________________________________ ________________________________________ Phone No: ( ) __________________ (telephone) ( ) __________________ (cellular) Email: __________________________________

PLEASE SELECT ONE OF THE CHOICES BELOW AND RETURN COPIES IN ENCLOSED ENVELOPES. _____ ELECTION OF MEDIATION The undersigned hereby request[s] that a mediation be scheduled to attempt to work out a resolution of the loan. ($200.00 Money Order or Cashier's Check Applies ­ See Below)

_____ WAIVER OF MEDIATION The undersigned is/are aware of the right to seek mediation but have determined that I/we do not want to proceed with a mediation and hereby waive the right to do so. The undersigned hereby certify under the penalty of perjury that I/we are the owner[s] of the real property that is the subject of the pending foreclosure and occupy the real property as my/our primary residence. _____________________________________
Signature of Property Owner Date

______________________________________
Signature of Co-Owner Date

COMPLETE TWO COPIES OF THIS FORM AND FORWARD ONE TO THE MEDIATION ADMINISTRATOR AND THE OTHER TO THE TRUSTEE OF THE DEED OF TRUST. TWO UNSTAMPED, PRE-ADDRESSED ENVELOPES HAVE BEEN ENCLOSED. IF YOU HAVE CHOSEN TO SEEK MEDIATION, YOU MUST SEND A MONEY ORDER OR CASHIER'S CHECK IN THE SUM OF $200 PAYABLE TO: "STATE OF NEVADA FORECLOSURE MEDIATION PROGRAM." THIS PAYMENT MUST BE RETURNED, BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED, WITHIN 30 DAYS OF THE DATE OF SERVICE OF THE NOTICE OF DEFAULT AND ELECTION TO SELL. PAYMENT MUST BE SENT TO THE TRUSTEE IN THE ENVELOPE THAT WAS ENCLOSED WITH THIS FORM. DO NOT SEND PAYMENT TO THE MEDIATION ADMINISTRATOR.

Election/Waiver of Mediation Form

FMP Form 001.063009

STATE OF NEVADA FORECLOSURE MEDIATION PROGRAM ELECTION/WAIVER OF MEDIATION FORM Instructions The Election/Waiver of Mediation is for owner-occupied residential property only. This form is not for use with vacation homes, rental property, or any other property where the owner does not live in the property as a primary residence. This form should come to you from the lender; you cannot begin this process yourself by using this form. The ELECTION/WAIVER OF MEDIATION form has been provided to you in duplicate. (You may make additional copies if needed.) You must fill out the forms in duplicate so that the same information is included on both copies of the forms. You must fill in the blanks on both forms and make your election to either request mediation or waive mediation. Print your name and address in the spaces provided. Include your telephone numbers and your email address. If you have a co-owner, their name, address, phone numbers and email address should be included. This information will only be used for the mediation process. In the designated location, you must select (with a check mark or "X") one of two choices. You may only select one of the two options. Either select: 1. "___ ELECTION OF MEDIATION" if you choose to enter into the Mediation Program; OR 2. "___ WAIVER OF MEDIATION" if you do not want to participate in the foreclosure Mediation Program. You must then sign and date each form. NOTE that by signing the form you are certifying under penalty of perjury that you own and occupy the subject property as your primary residence. Sign each form. One copy of the form must to be mailed to the Trustee of the deed of trust and one copy of the form must be mailed to the Mediation Administrator. The envelopes provided are preaddressed to the Trustee and Mediation Administrator. You must mail both envelopes by Certified U.S. mail, return receipt requested. You will need to pay the postage for the mailings. Do not mail your payment to the Mediation Administrator. If you elect mediation, you must include the $200.00 mediation fee along with the form in the envelope addressed to the trustee. The $200.00 mediation fee must be paid in the form of a money order or cashiers check and made payable to: "State of Nevada Foreclosure Mediation Program". If you choose to forego or waive mediation, there is no need to send the $200.00 mediation fee. However, whether you elect to enter into the mediation program or elect not to participate in mediation, both forms should be mailed. If you do not mail the forms to the Trustee and the Mediation Administrator, you will not be allowed to participate in the mediation program and the foreclosure will proceed. This is your only opportunity to elect to participate in the foreclosure mediation process.

Election/Waiver of Mediation Form

FMP Form 001.063009