Vanden Bos & Chapman, LLP



CREDITORS SECURED BY REAL PROPERTY(Trust Deeds, Mortgages, Judgment Liens, Tax Liens; HOA; Divorce Liens)IF DEBTOR IS USING AN ADDITIONAL PAGE(s) AND ATTACHING THAT PAGE(s) BEHIND THIS ONE, PLEASE CHECK HERE. Number of additional pages attached: . REAL PROPERTY NO. __ - Street Address of Property No: __: Brief Description of Property (i.e., Residence, Rental, Commercial, Bare Land, Tri-Plex, etc.):Property Fair Market Value: $ .Lienholder(s)REAL PROPERTY NO.__Secured Creditor’s Name Complete Correspondence/ Inquiry Address of CreditorCity, State & ZipRelationshipBank of America123 Main StIone, CA 96671 NoneLienholder 4Lienholder 5Lienholder 6REAL PROPERTY NO. ___Information to be Provided ExampleLienholder 4Lienholder 5Lienholder 6Nature of Lien (Trust Deed / Mortgage/HOA / Judgment/Tax Lien)Trust Deed1st , 2nd or 3rd Mortgage1st MortgageOriginal Amount of Mortgage /Judgment / Lien SEQ CHAPTER \h \r 1$200,000; Date of Mortgage / Judgment / Lien10/10/05Judgment – Court & Case No.Multnomah Circuit / 10cv12345Account No.12536478-02Interest Rate6.75%Current Balance30,000.00Monthly Payment550.00Current?NoIf Behind - How many months?2 monthsKeep or ReturnKeepCo-Signor/Guarantor NameAddressCity, State & ZipRelationshipExample: Donald Doe555 SW 5thPortland, OR 97205SonPART 2 – SECURED CREDITORS – List others to be notified for the debt that Debtor listed in Part 1 of Secured Creditors (i.e., attorney representing or attempting to collect debt on behalf of secured creditor, collection agency, etc.) Lienholder’s Nameand Indicate Real Property 1, 2, etc Name & Address of Others trying to collect same debtCity, State & ZipRelationshipBank of AmericaReal Property 1Jeffrey HouseAttorney at Law777 SW Low StreetPortland, OR 97221Attorney for Bank of AmericaLienholder’s Nameand Briefly Describe Real Property Name & Address of Others trying to collect same debtCity, State & ZipRelationshipJim and Hannah Brown 2010 AcuraJohn PriceAttorney at Law777 SW Hill StreetPortland, OR 97221Attorney for Jim and Hannah Brown ................
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