Free Local Bankruptcy Form 4008 - Colorado

Transitional Local Bankruptcy Form 4008.1 [Caption as in Bankruptcy Official Form No. 16B] COVER SHEET FOR REAFFIRMATION AGREEMENT This form must be completed in its entirety and filed within the time set under FED.R.BANKR.P. 4008. It may be filed by any party to the reaffirmation agreement. The filer also must attach a copy of the reaffirmation agreement to this cover sheet. Debtor's Name: __________________________ Creditor's Name: ________________________ 1. Amount of debt as of commencement of case: 2. Amount of debt being reaffirmed: $____________________ $____________________

3. Describe collateral, if any, securing debt: __________________________________________ ______________________________________________________________________________ 4. Repayment term of reaffirmation (number of months): ______________ 5. Monthly payment: Prior to reaffirmation: $______________ After reaffirmation: $______________ 6. Annual percentage rate under reaffirmation: Prior to reaffirmation: ______________ After reaffirmation: ______________ 7. Debtor's monthly income at time of reaffirmation: 8. Income from Schedule I, line 16: $___________________ $___________________ ________________________

9. Explain any difference in the amounts set out on lines 7 and 8:

______________________________________________________________________________ 10. Debtor's monthly expenses at time of reaffirmation: $___________________ (do not include the monthly expense of this reaffirmed debt) 11. Current expenditures from Schedule J, line 18: $___________________

12. Explain any difference in the amounts set out on lines 10 and 11: ______________________ ______________________________________________________________________________ 9 9 Check this box if the amount on Line 10 of this form exceeds the amount on Line 7 of this Form. If these expenses exceed the income, a presumption of undue hardship arises. Check this box if the debtor was not represented by counsel during the course of negotiating this reaffirmation agreement.

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 Cover Sheet for Reaffirmation Agreement. Dated: _____________________ By: _________________________________ Counsel /Agent for _____________________ Attorney registration number Business address Telephone number Facsimile number E-mail address

DEBTOR'S CERTIFICATION (see FED. R. BANKR. P. 4008(b)) I, (name of debtor) 12 of this form is true and correct. Dated: ______________________ By: _______________________________ Signature of debtor Printed name of debtor Home address Telephone number Facsimile number E-mail address , certify that any explanation contained on lines 9 or , certify that any explanation contained on lines 9 or

I, (name of joint-debtor) 12 of this form is true and correct. Dated: ______________________

By: _______________________________ Signature of joint-debtor, if any Printed name of joint-debtor Home address Telephone number Facsimile number E-mail address

ATTORNEY SIGNATURE Dated: _____________________ By: _________________________________ Counsel to ___________________________ Attorney registration number Business address Telephone number Facsimile number E-mail address