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Reaffirmation Documents B240A - Official Federal Forms
| Reaffirmation Documents Form. This is a national form and can be used in Procedural Forms Bankruptcy . |
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B240A (Form B240A) (12/09) Check one. G Presumption of Undue Hardship G No Presumption of Undue Hardship See Debtor's Statement in Support of Reaffirmation, Part II below, to determine which box to check. UNITED STATES BANKRUPTCY COURT District of In re Debtor , Case No. Chapter REAFFIRMATION DOCUMENTS Name of Creditor: ______________________________________ G Check this box if Creditor is a Credit Union I. REAFFIRMATION AGREEMENT Reaffirming a debt is a serious financial decision. Before entering into this Reaffirmation Agreement, you must review the important disclosures, instructions, and definitions found in Part V of this Reaffirmation Documents packet. 1. Brief description of the original agreement being reaffirmed: _________________________ For example, auto loan 2. AMOUNT REAFFIRMED: $___________________________ The Amount Reaffirmed is the entire amount that you are agreeing to pay. This may include unpaid principal, interest, and fees and costs (if any) arising on or before the date you sign this Reaffirmation Agreement. See the definition of "Amount Reaffirmed" in Part V.C below. 3. The ANNUAL PERCENTAGE RATE applicable to the Amount Reaffirmed is _________%. See definition of "Annual Percentage Rate" in Part V.C below. This is a (check one) Fixed rate Variable rate If the loan has a variable rate, the future interest rate may increase or decrease from the Annual Percentage Rate disclosed here. American LegalNet, Inc. www.FormsWorkFlow.com Form B240A, Reaffirmation Documents 4. Reaffirmation Agreement Repayment Terms: Page 2 G If fixed term, $________ per month for ________ months starting on____________. G If not fixed term, describe repayment terms: _______________________________. 5. Describe the collateral, if any, securing the debt: Description: Current Market Value ____________________________ $_____________ 6. Did the debt that is being reaffirming arise from the purchase of the collateral described above? G Yes G No $____________ $____________ If yes, what was the purchase price for the collateral? If no, what was the amount of the original loan? 7. Detail the changes made by this Reaffirmation Agreement to the most recent credit terms on the reaffirmed debt and any related agreement: Terms as of the Date of Bankruptcy Balance due (including fees and costs) Annual Percentage Rate Monthly Payment Terms After Reaffirmation $_________ ________% $__________ $________ ________% $________ 8. G Check this box if the creditor is agreeing to provide you with additional future credit in connection with this Reaffirmation Agreement. Describe the credit limit, the Annual Percentage Rate that applies to future credit and any other terms on future purchases and advances using such credit: ________________________________________ _______________________________________________________________ II. DEBTOR'S STATEMENT IN SUPPORT OF REAFFIRMATION AGREEMENT 1. Were you represented by an attorney during the course of negotiating this agreement? Check one. Q Yes Q No 2. Is the creditor a credit union? Check one. Q Yes Q No American LegalNet, Inc. www.FormsWorkFlow.com Form B240A, Reaffirmation Documents 3. If your answer to EITHER question 1. or 2. above is "No" complete a. and b. below. a.. My present monthly income and expenses are: i. Monthly income from all sources after payroll deductions (take-home pay plus any other income) ii. Monthly expenses (including all reaffirmed debts except this one) iii. Amount available to pay this reaffirmed debt (subtract ii. from i.) iv. Amount of monthly payment required for this reaffirmed debt Page 3 $_________ $_________ $_________ $_________ If the monthly payment on this reaffirmed debt (line iv.) is greater than the amount you have available to pay this reaffirmed debt (line iii.), you must check the box at the top of page one that says "Presumption of Undue Hardship." Otherwise, you must check the box at the top of page one that says "No Presumption of Undue Hardship." b. I believe this reaffirmation agreement will not impose an undue hardship on my dependents or on me because: Check one of the two statements below, if applicable: G I can afford to make the payments on the reaffirmed debt because my monthly income is greater than my monthly expenses even after I include in my expenses the monthly payments on all debts I am reaffirming, including this one. G I can afford to make the payments on the reaffirmed debt even though my monthly income is less than my monthly expenses after I include in my expenses the monthly payments on all debts I am reaffirming, including this one, because: _______________ ______________________________________________________________________ Use an additional page if needed for a full explanation. 4. If your answers to BOTH questions 1. and 2. above were "Yes," check the following statement, if applicable: G I believe this reaffirmation agreement is in my financial interest and I can afford to make the payments on the reaffirmed debt. Also, check the box at the top of page one that says "No Presumption of Undue Hardship." American LegalNet, Inc. www.FormsWorkFlow.com Form B240A, Reaffirmation Documents Page 4 III. CERTIFICATION BY DEBTOR(S) AND SIGNATURES OF PARTIES I (We) hereby certify that: i. I (We) agree to reaffirm the debt described above. ii. Before signing this reaffirmation agreement, I (we) read the terms disclosed in this Reaffirmation Agreement (Part I) and the Disclosure Statement, Instructions and Definitions included in Part V below; iii. The Debtor's Statement in Support of Reaffirmation Agreement (Part II above) is true and complete; iv. I am (We are) entering into this agreement voluntarily and fully informed of my (our) rights and responsibilities; and v. I (We) have received a copy of this completed and signed Reaffirmation Documents packet. SIGNATURE(S): Date _____________ Date _____________ Signature ________________________________________ Debtor Signature ________________________________________ Joint Debtor, if any If a joint reaffirmation agreement, both debtors must sign. Reaffirmation Agreement Terms Accepted by Creditor: Creditor Print Name Print Name of Representative Address Signature Date IV. CERTIFICATION BY DEBTOR'S ATTORNEY (IF ANY) To be filed only if the attorney represented the debtor during the course of negotiating this agreement. I hereby certify that: (1) this agreement represents a fully informed and voluntary agreement by the debtor; (2) this agreement does no
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