MEDIATION FORM | HOUSING COUNSELING

FORECLOSURE MEDIATION INTAKE FORM

Please complete all of the following information for MACON COUNTY COURTS In partnership with CICD FORECLOSURE MEDIATION INTAKE FORM.

BASIC INFORMATION HOMEOWNER #1
HOMEOWNER #1 INFORMATION (Homeowner #1 Abbreviated as H1)
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DEMOGRAPHIC INFORMATION OF HOMEOWNER #1 (Homeowner #1 Abbreviated as H1)
We are to provide ethnicity/race data to the U. S. Department of Housing and Urban Development as part of their standards. If you decline to provide the data, staff will be required to provide the missing information by observer identification.
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Veteran Status of Homeowner #1:
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EMPLOYMENT INFORMATION OF HOMEOWNER #1 (Homeowner #1 Abbreviated as H1)
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FAMILY AND LIVING INFORMATION OF HOMEOWNER #1 (Homeowner #1 Abbreviated as H1)
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BASIC INFORMATION HOMEOWNER #2
HOMEOWNER #2 INFORMATION (Homeowner #2 Abbreviated as H2)
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DEMOGRAPHIC INFORMATION OF HOMEOWNER #2 (Homeowner #2 Abbreviated as H2)
We are to provide ethnicity/race data to the U. S. Department of Housing and Urban Development as part of their standards. If you decline to provide the data, staff will be required to provide the missing information by observer identification.
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Veteran Status of Homeowner #2:
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EMPLOYMENT INFORMATION OF HOMEOWNER #2 (Homeowner #2 Abbreviated as H2)
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FAMILY AND LIVING INFORMATION OF HOMEOWNER #2 (Homeowner #2 Abbreviated as H2)
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HOUSEHOLD EXPENSE INFORMATION
Please enter all of your monthly household expenses.
MONTHLY EXPENSE
UTILITIES:
MEDICAL INSURANCE PREMIUMS:
CHILD SUPPORT PAID:
CHILDCARE PAID:
PRESCRIPTION COSTS:
GROCERIES:
CAR PAYMENT:
CAR INSURANCE:
MORTGAGE INFORMATION
Please enter all of your mortgage information.