UNITED STATES BANKRUPTCY COURT APPENDIX A

DISTRICT OF MARYLAND

SUMMARY OF REAFFIRMATION AGREEMENT

Name of Debtor(s)

Case No.

INSTRUCTIONS

1. Complete debtor's name and bankruptcy case number above.

2. PART A - Complete each item. Both the debtor(s) and creditor must sign.

3. PART B - Must be signed by attorney who represented debtor during course of negotiating the

reaffirmation agreement and should be left blank if the debtor had no attorney for

negotiation of the agreement.

4. File the fully completed form by mailing or delivering it to: Clerk, United States Bankruptcy Court.

PART A - AGREEMENT
Creditor's Name and Address	Terms of New Agreement a) Amount Principal $______________________________________ Interest Rate (APR) _____________________________ Monthly Payments $_______________________________ b) Security (collateral) Description:_____________________________________ _________________________________________________ Present Market Value $___________________________
Reason for Entry into Agreement
The parties understand that this agreement is purely voluntary and that the debtor(s) may rescind the agreement by giving notice of rescission to the creditor at any time prior to discharge or within sixty (60) days after such agreement is filed with the Clerk, whichever occurs later. This agreement was entered into before the date of discharge in the above case. DATE:______________________________ _________________________________________________________ Creditor's Signature _________________________________________________________ Debtor's Signature _________________________________________________________ Joint Debtor's Signature, if applicable
PART B - ATTORNEY'S DECLARATION
I declare under penalty of perjury that: (a) this agreement represents a fully informed and voluntary agreement by the debtor; (b) this agreement does not impose an undue hardship upon the debtor or a dependent of the debtor; and (c) I fully advised the debtor of the effect and consequences of this agreement and the consequences of any default under this agreement. Date:_______________________________ _________________________________________________________ Signature of Debtor's Attorney

Local Bankruptcy Form E

Return to Top of Page

Return to Rules Directory

Go to Maryland Law.net