Expression, Reaffirmation Agreement

• Court: United States Federal Court
• Legal Form Number: B 2400A
• Section: United States Federal Court

B2400A/B ALT (Form 2400A/B ALT) (12/15)

UNITED STATES BANKRUPTCY COURT

____________________District of___________________

In re ____________________________, Case No.__________________

Debtor Chapter________________

REAFFIRMATION AGREEMENT

[Indicate all documents included in this filing by checking each applicable box.]

G Part A: Disclosures, Instructions, and G Part D: Debtor’s Statement in

Notice to Debtor (pages 1 - 5) Support of Reaffirmation Agreement

G Part B: Reaffirmation Agreement G Part E: Motion for Court Approval

G Part C: Certification by Debtor’s Attorney

[Note: Complete Part E only if debtor was not represented by an attorney during

the course of negotiating this agreement. Note also: If you complete Part E, you must

prepare and file Form 2400C ALT - Order on Reaffirmation Agreement.]

Name of Creditor:______________________________________________

G [Check this box if] Creditor is a Credit Union as defined in §19(b)(1)(a)(iv) of the

Federal Reserve Act

PART A: DISCLOSURE STATEMENT, INSTRUCTIONS AND NOTICE TO DEBTOR

1. 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.

GPresumption of Undue Hardship

GNo Presumption of Undue Hardship

(Check box as directed in Part D: Debtor’s Statement

in Support of Reaffirmation Agreement.)