Fill and Sign the Summary of Reaffirmation Agreement Form

UNITED STATES BANKRUPTCY COURTEASTERN DISTRICT OF VIRGINIA SUMMARY OF REAFFIRMATION AGREEMENT Name of Debtor(s) Case No. Chapter INSTRUCTIONS: 1. Complete debtor's name, bankruptcy case number and chapter above. 2. PART A - Complete each ite m. Both the debtor(s) and creditor must sign. 3. PART B - Must be signed by the attorney who represents the debtor(s) in bankruptcy, if any. 4 . PART C - Complete only when debtor(s) not represented by attorney. 5. File the fully completed form by mail ing or delivering it to the Clerk of Court at an appropriate address as follows: PART A - AGREEMENT Creditor's Name and Address Date Set for Entry of Discharge Terms of New Agreement a ) Amount Principal $ ________________ Interest Rate (APR) ____________________ Monthly Payments $ ___________________________ b ) Security (collateral) Description Present Market Value $ ____________________________ The parties understand that this 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. This agreement was entered into before the date of discharge in the above case. The debtor(s) understands that this agreement is not required by the Bankruptcy Code, under nonbankruptcy law, or under any agreement not in accordance with ' 524(c) of the Bankruptcy Code. Date: _________________________ ________________________________________________________ Debtor's Signature ________________________________________________________ _______________________________________________________________ Creditor's Signature Joint Debtor's Signature, if applicable PART B - ATTORNEY'S DECLARATION This agreement represents a fully informed and voluntary agreement by the debtor(s) that does not impose an undue hardship on the debtor(s) or any dependent of the debtor(s). I have fully advised the debtor(s) of the legal effects and consequences of entering into an agreement of this kind and any default under this agreement.Attorney's Name and Address: ___________________________________________ ______________________________________________________ Signature of Debtor's Attorney ______________________________________________________________________________________ ______________________________________________________ Date PART C - MOTION FOR COURT APPROVAL OF AGREEMENT - Complete only where debtor(s) not represented by an attorney. I (we), the debtor, affirm the following to be true and correct: 1) I am not represented by an attorney in connection with this bankruptcy case. 2) My current monthly net income is $ . 3) My current monthly expenses total $ , including any payment due under this agreement.4) I believe that this agreement is in my best interest because $
¯éQ”ò~ Therefore, I ask the Court for an order approving this reaffirmation agreement. Date Signature of Debtor Signature of Joint Debtor, if applicable [ver. 09/11/97] [Name of Debtor and, if applicable, Joint Debtor] [Case No.] [Chapter] U. S. Bankruptcy Court, P. O. Box 19247, Alexandria, VA, 22320-0247 (Mailing) [Name & Complete Address of Creditor] [Amount of Monthly Payment] [Description of Property] [Description of Property - cont'd.] [Market Value of Property] [Complaint Deadline] [Name of Attorney] [Attorney Street or P.O. Address] [City, State & Zip] [Net Monthly Income] [Monthly Expenses] [Explanation of Best Interest] [Explanation, cont'd.][Explanation, cont'd.]