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Reaffirmation Agreement Cover Sheet CSD 1226 - California
| Reaffirmation Agreement Cover Sheet Form. This is a California form and can be used in General USBC Southern Federal . |
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CSD 1226 [10/01/12] Name, Address, Telephone No. & I.D. No. UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF CALIFORNIA 325 West "F" Street, San Diego, California 92101-6991 In Re BANKRUPTCY NO. Debtor. REAFFIRMATION AGREEMENT COVER SHEET This form must be completed in its entirety and filed, with t he reaffirmation agreement attached, within the time set under Fed . R. Bankr. P. 4008. It may be filed by any party to the reaffirmation agreement. 1. 2. Creditor's Name: Amount of the debt subject to this reaffirmation agreement: $ on the date of bankruptcy. to be paid under reaffirmation agreement. $ Annual percentage rate of interest: % under reaffirmation agreement ( Repayment terms (if fixed rate): $ % prior to bankruptcy Fixed Rate per month for Adjustable Rate) months 3. 4. 5. Collateral, if any, securing the debt: Current market value: $ Description: 6. Does the creditor assert that the debt is nondischargeable? Yes No (If yes, attach a declaration setting forth the nature of the debt and basis for the c ontention that the debt is nondischargeable.) Debtor's Schedule I and J Entries 7A. 8A. 9A. Total monthly income from Schedule I, line 16 Total monthly expenses from Schedule J, line 18 Total monthly payments on reaffirmed debts not listed on Schedule J $ $ $ Debtor's Income and Expenses as Stated on Reaffirmation Agreement 7B. 8B. 9B. Monthly income from all $ sources after payroll deductions Monthly expenses Total monthly payments on reaffirmed debts not included in monthly expenses $ $ 10B. Net monthly income $ (Subtract sum of lines 8B and 9B from line 7B. If total is less than zero, put the number in brackets.) American LegalNet, Inc. www.FormsWorkFlow.com CSD 1226 CSD 1226 (Page 2) 11. [10/01/12] Explain with specificity any difference between the income amounts (7A and 7B): 12. Explain with specificity any difference between the expense amounts (8A and 8B): If line 11 or 12 is completed, the undersigned debtor, and joint debtor if applicable, certifies that any explanation contained on those lines is true and correct. Signature of Debtor (only required if line 11 or 12 is completed) Other Information Signature of Joint Debtor (if applicable, and only required if line 11 or 12 is completed) Check this box if the total on line 10B is less than zero . If that number is less than zero, a presumption of undue hardship arises (unless the creditor is a credit union) and you must explain with specificity the sources of funds available to the debtor to make the monthly payments on the reaffirmed debt: Was debtor represented by counsel during the course of negotiating this reaffirmation agreement? Yes No If debtor was represented by counsel during the course of negotiating this reaffirmation agreement, has counsel executed a certification (affidavit or declaration) in support of the reaffirmation agreement? Yes No FILER'S CERTIFICATION I hereby certify that the attached agreement is a true and correct copy of the reaffirmation agreement between the parties identified on this Reaffirmation Agreement Cover Sheet. Signature Print/Type Name & Signer's Relation to Case CSD 1226 American LegalNet, Inc. www.FormsWorkFlow.com CSD 1226 [10/01/12] Name, Address, Telephone No. & I.D. No. UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF CALIFORNIA 325 West "F" Street, San Diego, California 92101-6991 In Re BANKRUPTCY NO. Debtor. REAFFIRMATION AGREEMENT Presumption of Undue Hardship No Presumption of Undue Hardship (Check box as directed in Part D: Debtor's Statement in Support of Reaffirmation Agreement.) Name of Creditor: [Check this box if] Creditor is a Credit Union as defined in § 19(b)(1)(a)(iv) of the Federal Reserve Act. PART A: 1. DISCLOSURE STATEMENT, INSTRUCTIONS AND NOTICE TO DEBTOR DISCLOSURE STATEMENT Before Agreeing to Reaffirm a Debt, Review These Important Disclosures: SUMMARY OF REAFFIRMATION AGREEMENT This Summary is made pursuant to the requirements of the Bankruptcy Code. AMOUNT REAFFIRMED The amount of debt you have agreed to reaffirm: $ The amount of debt you have agreed to reaffirm includes all fees and costs (if any) that have accrued as of the date of this disclosure. Your credit agreement may obligate you to pay additional amounts which may come due after the date of this disclosure. Consult your credit agreement. ANNUAL PERCENTAGE RATE [The annual percentage rate can be disclosed in different ways, depending on the type of debt.] a. If the debt is an extension of "credit" under an "open end credit plan," as those terms are defined in § 103 of the Truth in Lending Act, such as a credit card, the creditor may disclose the annual percentage rate shown in (i) below or, to the extent this rate is not readily available or not applicable, the simple interest rate showing in (ii) below, or both. CSD 1226 American LegalNet, Inc. www.FormsWorkFlow.com CSD 1226 (Page 2) [10/01/12] (i) The Annual Percentage Rate disclosed, or that would have been disclosed, to the debtor in the most recent periodic statement prior to entering into the reaffirmation agreement described in Part B below or, if no such periodic statement was given to the debtor during the prior six months, the annual percentage rate as it would have been so disclosed at the time of the disclosure statement: %. -- And/Or -- (ii) The simple interest rate applicable to the amount reaffirmed as of the date this disclosure statement is given to the debtor: %. If different simple interest rates apply to different balances included in the amount reaffirmed, the amount of each balance and the rate applicable to it are: $ $ $ @ @ @ %; %; %. b. If the debt is an extension of credit other than under an open end credit plan, the creditor may disclose the annual percentage rate showing in (i) below, or, to the extent this rate is not readily available or not applicable, the simple interest rate showing in (ii) below, or both. (i) The Annual Percentage Rate under § 128(a)(4) of the Truth in Lending Act, as disclosed to the debtor in the most recent disclosure statement given to the debtor prior to entering into the reaffirmation agreement with respect to the debt or, if no such disclosure statement was given to the debtor, the annual %. percentage rate as it would have been so disclosed: -- And/Or -- (ii) The simple interest rate applicable to the amount reaffirmed as of the date this disclosure statement is given to the debtor: %. If different simple interest rates apply to different balances included in the amount
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