Form B27 - Reaffirmation Agreement Cover Sheet Page 2
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2B27 (Official Form 27) (12/09)
Page 2
11.
Explain with specificity any difference between the income amounts (7A and 7B):
____________________________________________________________________
____________________________________________________________________
12.
Explain with specificity any difference between the expense amounts (8A and 8B):
____________________________________________________________________
____________________________________________________________________
If line 11 or12 is completed, the undersigned debtor, and joint debtor if applicable, certifies that
any explanation contained on those lines is true and correct.
______________________________
_______________________________________
Signature of Debtor (only required if
Signature of Joint Debtor (if applicable, and only
line 11 or 12 is completed)
required if line 11 or 12 is completed)
Other Information
G
Check this box if the total on line 10B is less than zero. If that number is less than zero, a
presumption of undue hardship arises (unless the creditor is a credit union) and you must explain with
specificity the sources of funds available to the Debtor to make the monthly payments on the
reaffirmed debt: _______________________________________________________________
_______________________________________________________________
Was debtor represented by counsel during the course of negotiating this reaffirmation agreement?
_____Yes
______No
If debtor was represented by counsel during the course of negotiating this reaffirmation agreement, has
counsel executed a certification (affidavit or declaration) in support of the reaffirmation agreement?
_____Yes
______No
FILER’S CERTIFICATION
I hereby certify that the attached agreement is a true and correct copy of the reaffirmation
agreement between the parties identified on this Reaffirmation Agreement Cover Sheet.
____________________________________
Signature
____________________________________
Print/Type Name & Signer’s Relation to Case
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