Fill in this information to identify the case:

Debtor 1 Susan Jeanette Palma

Debtor 2

(Spouse, if filing)

United States Bankruptcy Court for the: Eastern District of Virginia

(State)

Case number 16-10471-BFK

Official Form 410S1

Notice of Mortgage Payment Change 12/15

If the debtor’s plan provides for payment of postpetition contractual installments on your claim secured by a security interest in the 

debtor’s principal residence, you must use this form to give notice of any changes in the installment payment amount. File this form 

as a supplement to your proof of claim at least 21 days before the new payment amount is due. See Bankruptcy Rule 3002.1.

Name of creditor:

Citizens Bank, N.A. f/k/a RBS 

Citizens, N.A. Court claim no. (if known): NA

Last 4 digits of any number you use to Date of payment change:

identify the debtor’s account: XXXXXX2260 Must be at least 21 days after date December 4, 2016

of this notice

New total payment:

$ 734.96

Principal, interest, and escrow, if any

Part 1: Escrow Account Payment Adjustment

1. Will there be a change in the debtor’s escrow account payment?

No

Yes. Attach a copy of the escrow account statement prepared in a form consistent with applicable nonbankruptcy law. Describe

the basis for the change. If a statement is not attached, explain why:

Current escrow payment: $ 232.74 New escrow payment: $ 222.50

Part 2: Mortgage Payment Adjustment

2. Will the debtor’s principal and interest payment change based on an adjustment to the interest rate on the debtor's

variable-rate account?

No

Yes. Attach a copy of the rate change notice prepared in a form consistent with applicable nonbankruptcy law. If a notice is not

attached, explain why:

Current interest rate: % New interest rate: %

Current principal and interest payment: $ New principal and interest payment: $

Part 3: Other Payment Change

3. Will there be a change in the debtor’s mortgage payment for a reason not listed above?

No

Yes. Attach a copy of any documents describing the basis for the change, such as a repayment plan or loan modification agreement.

(Court approval may be required before the payment change can take effect.)

Reason for change: 

Current mortgage payment: $ New mortgage payment: $

Official Form 410S1 Notice of Mortgage Payment Change page 1

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Debtor 1 Susan Jeanette Palma Case number (if known) 16-10471-BFK

Part 4: Sign Here

The person completing this Notice must sign it. Sign and print your name and your title, if any, and state your address and 

telephone number.

Check the appropriate box.

 I am the creditor

☒ I am the creditor’s authorized agent.

I declare under penalty of perjury that the information provided in this claim is true and correct to the best of my 

knowledge, information, and reasonable belief.

 /s/ Nisha R. Patel Date 11/1/2016

Signature

Print: Nisha R. Patel Title Attorney for Creditor

First Name Middle Name Last Name

Company Samuel I. White, P.C.

Address 1804 Staples Mill Road Suite 200

Number Street

Richmond, VA 23230

City State ZIP Code

Contact phone (804) 290-4290 Email npatel@siwpc.com

Official Form 410S1 Notice of Mortgage Payment Change page 2

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CERTIFICATE OF SERVICE

I certify that on November 1, 2016, the foregoing Notice of Payment Change was served via CM/ECF on 

Janet M. Meiburger, Trustee, and Robert Brandt, Counsel for Debtor, at the email addresses registered with the 

Court, and that a true copy was mailed via first class mail, postage prepaid, to Susan Jeanette Palma, Debtor, 

17626 Duke Street, Dumfries, VA 22026.

/s/ Nisha R. Patel

Nisha R. Patel, Esquire

Samuel I. White, P. C.

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