MOW 3094.1.5 (10/08)
IN THE UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF MISSOURI
PROOF OF CLAIM ADDENDUM FOR REAL ESTATE CLAIMS Debtor: Case No. Creditor
1. PRE-PETITION ARREARAGE: a. Mortgage Payments # _______ @ $____________ b. Late Fees - # _______@ $_______________ c. Other Fees i. Inspection Fee - $_______________ ii. Escrow Shortage - $_________________ iii. Attorney's Fees - $__________________ d. TOTAL ARREARAGE: $_______________
2, ESTIMATED PAYOFF: a. b. c. d. e. f. g. Unpaid Principal Balance - $_________________ Interest from Last Paid Installment - $__________________ Escrow Shortage - $_______________ Late Fees - $______________ Property Inspection Fee $_____________ Other TOTAL ESTIMATED PAYOFF: $_______________
2. CURRENT MONTHLY PAYMENT: a. b. c. d. e. Principal and Interest payment - $__________________ Escrow Payment - $______________ TOTAL CURRENT MONTHLY PAYMENT - $_____________ Effective Date of Current Monthly Payment: CURRENT CONTRACT RATE OF INTEREST: ___________%