Official Form 410S1 Notice of Mortgage Payment Change page 1

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: _______________________________________ Court claim no. (if known): _____________________ 

Last 4 digits of any number you use to 

identify the debtor’s account: ____ ____ ____ ____ 

Date of payment change: 

Must be at least 21 days after date 

of this notice 

_____________ 

New total payment:

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: $ _______________ New escrow payment: $ _______________

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: $ _______________

Debtor 1 __________________________________________________________________ 

Debtor 2 ________________________________________________________________ 

(Spouse, if filing)

United States Bankruptcy Court for the: __________ District of __________ 

Case number ___________________________________________ 

 Fill in this information to identify the case: 

Ray A Woods Northern District of Illinois 16-29636

US Bank Trust National Association, as trustee of

Bungalow Series F Trust 2-1 0 6 8 4 12/01/2019977.02 ✔

411.45 370.19 ✔

✔

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Debtor 1 _______________________________________________________ Case number (if known) _____________________________________ First Name Middle Name Last Name

Official Form 410S1 Notice of Mortgage Payment Change page 2

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. 

_____________________________________________________________ Date ___________________ 

Signature

Print: _________________________________________________________ Title ___________________________

First Name Middle Name Last Name

Company _________________________________________________________

Address _________________________________________________________

Number Street

___________________________________________________

City State ZIP Code

Contact phone ________________________ Email ________________________ 

Ray A Woods 16-29636 ✔

/s/ Michelle R. Ghidotti-Gonsalves 11/05/2019 Michelle R. Ghidotti-Gonsalves Authorized Agent for Secured Creditor Ghidotti | Berger LLP 1920 Old Tustin Avenue Santa Ana CA 92705 (949) 427-2010 mghidotti@ghidottiberger.com Print Save As... Add Attachment Reset

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Document Page 2 of 5
314 S. Franklin Street, 2nd Floor 

P.O. Box 517 

Titusville, PA 16354 

1-800-327-7861 

https://myloanweb.com/BSI 

Licensed as Servis One, Inc. dba BSI Financial Services. BSI Financial Services NMLS# 38078. Colorado Office Location: 7200 S. Alton Way, Ste.

B180, Centennial, CO 80112 (303) 309-3839. Licensed as a Debt Collection Agency by the New York City Department of Consumer Affairs, (#

2001485-DCA). North Carolina Collection Agency Permit (# 105608). 

PROPERTY ADDRESS

9746 S TORRENCE AVE

CHICAGO, IL 60617

RAY WOODS

9746 S TORRENCE AVE

CHICAGO, IL 60617

 349

DATE: 10/22/19

ACCOUNT NUMBER: 

Annual Escrow Account

Disclosure Statement

PLEASE REVIEW THIS STATEMENT CLOSELY - YOUR MORTGAGE PAYMENT MAY BE AFFECTED. THIS STATEMENT TELLS

YOU OF ANY CHANGES IN YOUR MORTGAGE PAYMENT, ANY SURPLUS REFUNDS, OR ANY SHORTAGE YOU MUST PAY.

IT ALSO SHOWS YOU THE ANTICIPATED ESCROW ACTIVITY FOR YOUR ESCROW CYCLE BEGINNING 12/01/2019

THROUGH 11/30/2020.

 -------- ANTICIPATED PAYMENTS FROM ESCROW 12/01/2019 TO 11/30/2020 ---------

HOMEOWNERS INS $3,263.00

COUNTY TAX $1,179.37

TOTAL PAYMENTS FROM ESCROW $4,442.37

MONTHLY PAYMENT TO ESCROW $370.19

 ------ ANTICIPATED ESCROW ACTIVITY 12/01/2019 TO 11/30/2020 ---------

 ANTICIPATED PAYMENTS ESCROW BALANCE COMPARISON

MONTH TO ESCROW FROM ESCROW DESCRIPTION ANTICIPATED REQUIRED

 STARTING BALANCE --> $4,144.69 $1,480.85

DEC $370.19 $4,514.88 $1,851.04

JAN $370.19 $4,885.07 $2,221.23

FEB $370.19 $5,255.26 $2,591.42

MAR $370.19 $611.90 COUNTY TAX $5,013.55 $2,349.71

APR $370.19 $5,383.74 $2,719.90

MAY $370.19 $5,753.93 $3,090.09

JUN $370.19 $6,124.12 $3,460.28

JUL $370.19 $3,263.00 HOMEOWNERS INS $3,231.31 $567.47

AUG $370.19 $567.47 COUNTY TAX L1-> $3,034.03 L2-> $370.19

SEP $370.19 $3,404.22 $740.38

OCT $370.19 $3,774.41 $1,110.57

NOV $370.19 $4,144.60 $1,480.76

 --------- DETERMINING THE SUFFICIENCY OF YOUR ESCROW BALANCE --------

IF THE ANTICIPATED LOW POINT BALANCE (L1) IS GREATER THAN THE REQUIRED BALANCE (L2), THEN YOU HAVE AN

ESCROW SURPLUS. YOUR ESCROW SURPLUS IS $2,663.84.

 CALCULATION OF YOUR NEW PAYMENT 

PRIN & INTEREST $606.83

ESCROW PAYMENT $370.19

NEW PAYMENT EFFECTIVE 12/01/2019 $977.02

YOUR ESCROW CUSHION FOR THIS CYCLE IS $370.19.

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Our records indicate that you have filed for Bankruptcy protection. As a result of your

Bankruptcy filing, escrow account deficiencies prior to your filing date have been removed

from calculation of your analysis, and they are now reflected as amounts due within your

pre-petition arrearage. This Escrow Analysis Statement was prepared under the

assumption that all escrow payments have been made in the amount required each

month. The surplus funds indicated above are not an accurate reflection of your escrow

account because no surplus funds will exist until all amounts are received towards your

pre-petition arrearage. 

004 1461810684_ESCROWDISCSTMT_191022 

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 ACCOUNT HISTORY

THIS HISTORY STATEMENT COMPARES YOUR PRIOR ANALYSIS CYCLE PROJECTED ESCROW ACTIVITY TO THE ACTUAL

ESCROW ACTIVITY BEGINNING 12/01/2018 AND ENDING 11/30/2019. IF YOUR LOAN WAS PAID-OFF, ASSUMED OR

TRANSFERRED DURING THIS PRIOR CYCLE, OR THE COMPUTATION YEAR IS BEGING CHANGED, ACTUAL ACTIVITY STOPS AT

THAT POINT. THIS STATEMENT IS INFORMATION ONLY AND REQUIRES NO ACTION ON YOUR PART.

YOUR PAYMENT BREAKDOWN AS OF 12/01/2018 IS:

PRIN & INTEREST $606.83

ESCROW PAYMENT $411.45

BORROWER PAYMENT $1,018.28

 PAYMENTS TO ESCROW PAYMENTS FROM ESCROW ESCROW BALANCE

MONTH PRIOR PROJECTED ACTUAL PRIOR PROJECTED ACTUAL DESCRIPTION PRIOR PROJECTED ACTUAL

 STARTING BALANCE $0.00 $4,054.60-

DEC $0.00 $364.34 * T-> $0.00 A-> $3,690.26-

JAN $0.00 $778.78 * $0.00 $2,911.48-

FEB $0.00 $800.84 * $611.90 * COUNTY TAX $0.00 $2,722.54-

MAR $0.00 $411.45 * $0.00 $2,311.09-

APR $0.00 $822.90 * $0.00 $1,488.19-

MAY $0.00 $411.45 * $0.00 $1,076.74-

JUN $0.00 $822.90 * $3,263.00 * HOMEOWNERS INS $0.00 $3,516.84-

JUL $0.00 $822.90 * $567.47 * COUNTY TAX $0.00 $3,261.41-

AUG $0.00 $411.45 * $0.00 $2,849.96-

SEP $0.00 $822.90 * $0.00 $2,027.06-

OCT $0.00 $411.45 * $0.00 $1,615.61- __________ __________ __________ __________

 $0.00 $6,881.36 $0.00 $4,442.37

UNDER FEDERAL LAW, WHEN YOUR ACTUAL ESCROW BALANCE REACHED THE LOWEST POINT, THAT BALANCE WAS

TARGETED NOT TO EXCEED 1/6TH OF THE ANNUAL PROJECTED DISBURSEMENTS. YOUR LOAN DOCUMENTS OR STATE

LAW MAY SPECIFY THAT YOUR LOWEST BALANCE MUST BE A LOWER AMOUNT THAN THE FEDERAL LAW ALLOWS.

UNDER YOUR MORTGAGE CONTRACT OR STATE OR FEDERAL LAW, YOUR TARGETED LOW POINT BALANCE (T) WAS

$0.00. YOUR ACTUAL LOW POINT ESCROW BALANCE (A) WAS $3,690.26-.

BY COMPARING THE ANTICIPATED ESCROW TRANSACTIONS WITH THE ACTUAL TRANSACTIONS YOU CAN DETERMINE

WHERE A DIFFERENCE MAY HAVE OCCURRED. AN ASTERISK (*) INDICATES A DIFFERENCE IN EITHER THE AMOUNT OR

DATE OF THE PROJECTED ACTIVITY THAT HAS NOT YET OCCURRED DUE TO THE DATE OF THIS STATEMENT. 

IF THERE ARE NO PRIOR PAYMENTS TO OR FROM ESCROW SHOWN, THERE WAS NO PRIOR PROJECTION TO WHICH THE

ACTUAL ACTIVITY COULD BE COMPARED. 

Determining your Shortage or Surplus

Shortage:

Any shortage in your escrow account is usually caused by one the following items: An increase, if any, in what was paid for insurance and/or taxes from your escrow account.

A projected increase in taxes for the upcoming year.

The number of months elapsed from the time of these disbursements to the new payment effective date.

Shortages are divided evenly of the next twelve months. To reduce the increase in your monthly payment, the

shortage can be paid either partially or in full.

Surplus:

A surplus in your escrow account is usually caused by one the following items: The insurance/taxes paid during the past year were lower than projected.

A refund was received from the taxing authority or insurance carrier.

Additional funds were applied to your escrow account.

If your surplus is $50.00 or greater and your loan was contractually current at the time when the analysis was

run or calculated, a check will be sent to you. If your surplus is less than $50.00, the funds will be retained in

your escrow account. 

...

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********** Continued from front **********

If you have filed a bankruptcy petition and there is either an "automatic stay" in effect in your bankruptcy case or you have received a discharge of your personal liability for the obligation identified in this letter, we

may not and do not intend to pursue collection of that obligation from you personally. If these circumstances apply, this notice is not and should not be construed to be a demand for payment from you personally.

Unless the Bankruptcy Court has ordered otherwise, please also note that despite any such bankruptcy filing, whatever rights we hold in the property that secures the obligation remain unimpaired

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CERTIFICATE OF SERVICE

On November 5, 2019, I served the foregoing documents described as Notice of Mortgage 

Payment Change on the following individuals by electronic means through the Court’s ECF program:

COUNSEL FOR DEBTOR

David M Siegel

davidsiegelbk@gmail.com

I declare under penalty of perjury under the laws of the United States of America that the 

foregoing is true and correct.

/s/ Evan Tragarz

Evan Tragarz

On November 5, 2019, I served the foregoing documents described as Notice of Mortgage 

Payment Change on the following individuals by depositing true copies thereof in the United States mail 

at Santa Ana, California enclosed in a sealed envelope, with postage paid, addressed as follows: 

Debtor 1

Ray A Woods

9746 S. Torrence Ave.

Chicago, IL 60617

Trustee

Tom Vaughn

55 E. Monroe Street, Suite 3850

Chicago, IL 60603

U.S. Trustee

Patrick S Layng

Office of the U.S. Trustee, Region 11

219 S Dearborn St

Room 873

Chicago, IL 60604

I declare under penalty of perjury under the laws of the United States of America that the 

foregoing is true and correct.

/s/ Evan Tragarz

Evan Tragarz

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