Verification Of Qualifications To Acs As Mediator In The Mortgage Modification Mediation Program

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Attorney Name and State Bar Number
Address 1
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City, State, Zip
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Email
Telephone Number
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UNITED STATES BANKRUPTCY COURT
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NORTHERN DISTRICT OF CALIFORNIA
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In re
VERIFICATION OF
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MORTGAGE MODIFICATION MEDIATION
QUALIFICATIONS TO ACT AS
PROGRAM.
MEADIATOR IN THE MORTGAGE
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MODIFICATION MEDIATION
PROGRAM
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I,
, hereby declare as follows:
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1.
I am seeking to be included on the Register of Mediators maintained by the Clerk
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of the Court for purposes of the Mortgage Modification Mediation Program (the “MMM
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Program”). I have personal knowledge of the following and could testify competently thereto if
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called upon to do so.
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2.
In accordance with General Order 29, I verify that I am qualified to serve as a
mediator for a period of three (3) years, after which I must reapply, based upon the following
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qualification (select one):
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I am an active and licensed member of the State Bar of California and
admitted to practice law in a state court or federal court within California
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for at least the past five (5) years;
I am a retired California state court or federal court judge; or
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I am an active and licensed member of the State Bar of Florida and an
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approved member on the Register of Mediators with the Clerk of the Court
for the United States Bankruptcy Court, District of Florida (all divisions)
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accepting MMM Assignments, and I will accept MMM Assignments for a
period limited to one (1) year commencing August 1, 2015 and ending July
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31, 2016.
3.
I have never been disbarred or suspended from practice before any court,
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department, bureau or commission of any state or the United States, and I have never received a
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1
VERSION 1.00 (August 1, 2015)
FORM ND-MMM-200
VERIFICATION OF QUALIFICATIONS TO ACT AS MEADIATOR IN THE MORTGAGE MODIFICATION MEDIATION PROGRAM

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