Form 240a Sample - Reaffirmation Agreement Page 9
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10Form 240A - Reaffirmation Agreement (Cont.)
8
PART D: DEBTOR’S STATEMENT IN SUPPORT OF REAFFIRMATION AGREEMENT
These two
[Read and complete sections 1 and 2, OR, if the creditor is a Credit Union and
amounts must be
filled in unless the
the debtor is represented by an attorney, read section 3. Sign the appropriate
creditor is a credit
signature line(s) and date your signature. If you complete sections 1 and 2
union AND the
and your income less monthly expenses does not leave enough to make the
debtor is
payments under this reaffirmation agreement, check the box at the top of page
represented by an
1 indicating “Presumption of Undue Hardship.” Otherwise, check the box at
attorney.
the top of page 1 indicating “No Presumption of Undue Hardship”]
Depending on the
information
provided here, a
1. I believe this reaffirmation agreement will not impose an undue hardship on my
hearing may be
dependents or me. I can afford to make the payments on the reaffirmed debt because my
set EVEN IF the
monthly income (take home pay plus any other income received) is $________, and my actual
attorney's
current monthly expenses including monthly payments on post-bankruptcy debt and other
statement of No
reaffirmation agreements total $________, leaving $________ to make the required payments
Hardship has
been provided in
on this reaffirmed debt.
Part C.
I understand that if my income less my monthly expenses does not leave enough to
make the payments, this reaffirmation agreement is presumed to be an undue hardship on me
and must be reviewed by the court. However, this presumption may be overcome if I explain
to the satisfaction of the court how I can afford to make the payments here:
.
(Use an additional page if needed for a full explanation.)
2. I received a copy of the Reaffirmation Disclosure Statement in Part A and a
completed and signed reaffirmation agreement.
Debtor(s) must sign here unless the creditor is
Signed: ____________________________________
a credit union AND the debtor is represented
(Debtor)
by an attorney.
_____________________________________
(Joint Debtor, if any)
Date: ___________________
— Or —
[If the creditor is a Credit Union and the debtor is represented by an attorney]
3. I believe this reaffirmation agreement is in my financial interest. I can afford to
make the payments on the reaffirmed debt. I received a copy of the Reaffirmation Disclosure
Statement in Part A and a completed and signed reaffirmation agreement.
Debtor(s) must sign here if the creditor is a credit
Signed: ____________________________________
union AND the debtor is represented by an
(Debtor)
attorney.
_____________________________________
(Joint Debtor, if any)
Date: ___________________
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