Official Form 427 Cover Sheet For Reaffirmation Agreement Page 2
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34. Does collateral secure
No
the debt?
Yes. Describe the collateral.
________________________________________________________________
Current market value
$
5. Does the creditor assert
No
that the debt is
nondischargeable?
Yes. Attach an explanation of the nature of the debt and the basis for contending that the debt is nondischargeable.
6. Using information from
Income and expenses reported on Schedules I and J
Income and expenses stated on the reaffirmation agreement
Schedule I: Your Income
(Official Form 106I) and
6e. Monthly income from all sources
$
6a. Combined monthly income from
$
Schedule J: Your
after payroll deductions
line 12 of Schedule I
Expenses (Official Form
6f. Monthly expenses
–
106J), fill in the amounts.
$
6g. Monthly payments on all
–
$
6b. Monthly expenses from line 22c of
–
$
reaffirmed debts not included in
Schedule J
monthly expenses
6h. Present net monthly income
$
6c. Monthly payments on all
–
$
Subtract lines 6f and 6g from 6e.
reaffirmed debts not listed on
If the total is less than 0, put the
Schedule J
number in brackets.
6d. Scheduled net monthly income
$
Subtract lines 6b and 6c from 6a.
If the total is less than 0, put the
number in brackets.
Debtor 1
_________________________________________________________
Case number
(if known)_____________________________________________________________
First Name
Middle Name
Last Name
Debtor 2
_________________________________________________________
First Name
Middle Name
Last Name
7. Are the income amounts
No
on lines 6a and 6e
Yes. Explain why they are different and complete line 10.
different?
_____________________________________________________________________________________
No
8. Are the expense
amounts on lines 6b
Yes. Explain why they are different and complete line 10.
and 6f different?
_______________________________________________________________________________________
9. Is the net monthly
No
income in line 6h less
Yes. A presumption of hardship arises (unless the creditor is a credit union).
than 0?
Explain how the debtor will make monthly payments on the reaffirmed debt and pay other living expenses.
Complete line 10.
______________________________________________________________________________________
______________________________________________________________________________________
Official Form 427
Cover Sheet for Reaffirmation Agreement
page 2
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