Fill and Sign the Reaffirmation Agreement Louisiana Form

UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF LOUISIANA REAFFIRMATION AGREEMENT Name of Debtor(s)       Bankruptcy Case No.       INSTRUCTIONS: 1) Write Debtor’s name and bankruptcy case number above and attach written agreement, if any. 2) PART A – Must be signed by both the Debtor(s) and the Creditor. 3) PART B – Must be signed by the Debtor’s bankruptcy attorney. 4) PART C – Must be completed by the Debtor(s) if NOT represented by an attorney. 5) If Debtor is (Debtors are) NOT represented by an attorney, an original and two (2) copies of the Reaffirmation Agreement and separate order for hearing together with a self-addressed, stamped envelope MUST be filed with the Reaffirmation Agreement. PART A – AGREEMENT Creditor’s Name and Address                   Summary of Terms of New AGREEMENT 1) Principal Amount $       Interest Rate (APR)       Monthly Payments $       __________________________ ______________________________ Date Set for Discharge 2) Description of Security             Present Market Value $       The parties understand that the agreement is purely voluntary and that the debtor(s) may rescind the agreement at any time prior to discharge or within 60 days after such agreement is filed with the court, whichever occurs later, by giving notice of rescission to the creditor; that such agreement is not required under this title, under non-bankruptcy law, or under any agreement not in accordance with the provisions of 524(c). _________________________________ Date ______________________________________________ Signature of Creditor ___________________________________________ Signature of Debtor ___________________________________________ Signature of Joint Debtor PART B – ATTORNEY’S DECLARATION This agreement represents a fully informed and voluntary agreement by the debtors) and does not impose an undue hardship on the debtor(s) or any dependent of the debtor(s). The debtor(s) has (have) been fully advised of the legal effect and consequences of this agreement and any default under this agreement. ______________________________________________ __________________________________________ Date Signature of Attorney for Debtor(s) PART C – MOTION FOR COURT APPROVAL OF REAFFIRMATION AGREEMENT Complete ONLY if debtor is NOT represented by an attorney. I (We), the debtor(s), affirm the following to be true and correct: 1) I am not (We are not) represented by an attorney in connection with this bankruptcy case. 2) My (Our) current monthly net income is $       . 3) My (Our) current monthly expenses total $       , including any payment due under this reaffirmation agreement. 4) I (We) believe that this agreement is in my (our) best interest because                   Therefore, I (we) ask the court for an order approving this reaffirmation agreement. _________________________________________________ ____________________________________________ Date Signature of Debtor ____________________________________________ Signature of Joint Debtor B240