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When do you have to have a solution by:
Is there a current Notice of Default?	Yes No
When was Notice of Default filed?
Do you want to stay in your house?	Yes No
What can you afford as a new monthly payment?
What are the following account balances:
1st Mortgage:
2nd Mortgage:
Amount of any liens attached to the property:
Amount of any unpaid judgments attached to the property:
Approximate value of your property:
Are you working with a Real Estate Agent?	Yes No
Have you filed or intend on filing bankruptcy?	Yes No