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IN THE SUPERIOR COURT OF THE STATE OF DELAWARE

Plaintiff(s),

C. A. No.:

Defendant(s).

Certificate of Participation for Automatic Residential Mortgage Foreclosure Mediation Program

If you own and occupy a one-to-four family primary residential property in Delaware that is being foreclosed upon, you have a right to

participate in the Automatic Residential Mortgage Foreclosure Mediation Program (the “Mediation Program”).

A mediation conference has been or will be scheduled for you.

Please complete this certificate and sign it where indicated below.

Property Address that is the subject of mortgage foreclosure action:

__________________________________________________

Telephone: ______________________

__________________________________________________

Email: _________________________

__________________________________________________

I am the borrower: ___YES ___NO

I occupy this property as my primary residence: ___YES ___NO

I want to keep living in this house or otherwise negotiate a resolution to this foreclosure that will not result in sheriff’s sale: ___YES

___NO

If you checked “NO” for any of the above statements, your mediation conference will be cancelled, the foreclosures action may go

forward, and the plaintiff may be permitted to seek judgment against you if you fail to file an answer within the time period

allowed by law.

In order to effectively participate in the Mediation Program, you should work with and through a HUD-approved housing counselor or

with an attorney who is employed by non-profit legal services provider in Delaware, who will be your “Housing Representative.”

Have you contacted (or tried to contact) a Housing Counselor: __YES (do you have an appointment When? _____________) __NO

My Housing Representative is:

Name:__________________________ Agency/Firm: _______________________________

Agency/Firm address for e-mailing documents: __________________________________________________________

Is your spouse or another person also listed as a co-borrower on your mortgage loan? ___YES ___NO.

If YES, do you authorize your co-borrower to participate in mediation on your behalf, and to sign mediation-related court

documents that will bind you?

___YES (co-borrower’s name: ________________________________________) ___NO

Unless you checked “YES” to authorize a co-borrower to act for you, all defendants should attend all mediation conferences.

I represent that the information herein is true, and certify that as required by the Automatic Residential Mortgage Foreclosure

Mediation Program, I have met with the Housing Representative identified above (if any) and a proposal will be submitted on my

behalf to Plaintiff’s attorney at least 14 days before the date of the mediation conference.

_______________________________________

______________

Signature

Date

Print name: _________________________________

[Cause this Certificate to be E-filed with the Superior Court by (1) sending the certificate as a pdf document by electronic mail to the

Program Administrator, who will then E-file the Certificate of Participation; (2) Delivering three copies of the Certificate of

Participation to the Program Administrator, who will then E-file a scanned copy of the Certification of Participation; or (3) E-filing

directly with the Court.]

Certificate Of Participation For Automatic Residential Mortgage Foreclosure Mediation Program - Delaware Superior Court

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