County: ___ Case Number: ___ FC ___ Parties: ___
17th Judicial Circuit Foreclosure Mediation Program
(This document must be submitted to the Program Administrator at least 10 calendar days before the first mediation management conference or mediation session.)
Please list a contact person for this case. The Program Administrator will contact this person to deal with any issues. The contact person may be an attorney representing the plaintiff.
Name:
___
Title: ___
Telephone Number: ___
E-mail address:
___
Loan servicer:
___
Does the plaintiff have a second lien on the home?
□ Yes □ No
(If yes, please answer A and B below.)
Does the plaintiff or the loan servicer participate in Second Lien Modification Program (2MP)?
□ Yes □ No
Does the plaintiff or the loan servicer have another program addressing a second lien?
□ Yes □ No
(If yes, please attach a description of the program to this checklist.)
Please indicate the owner of the loan and any other boxes that apply:
□ Fannie Mae □ Ginnie Mae □ FHA Loan □ RHS Loan □ Freddie Mac □ Private Investor Owned
☐ VA Loan ☐ Other: _____
Has the lender received a complete packet and all required documents necessary for review?
□ Yes □ No
(If no, please attach an itemized list of the missing documents to this checklist.)
Lender/servicer-specific loss mitigation application materials were due to the Mediation Program within 10 calendar days of the Notice of Entry. Please select the appropriate option below:
☐ Lender/servicer-specific application materials were sent to FM@17thCircuit.IllinoisCourts.gov on _____(date).
□ The forms provided by the Mediation Program include: Request for Mortgage Assistance (RMA), Mortgage Assistance Application (Form 710), Dodd-Frank Certification, IRS Forms 4506C & 4506T, the Financial Worksheet, and the Hardship Letter. Lender/servicer-specific materials were not sent to the Mediation Program as the above-listed forms are accepted by the lender/servicer.