Free Reaffirmation Agreement (Pre-Reform Act Case - Secured Debt) - South Dakota

Appendix 39 (Revised 09/28/06)

Sample Reaffirmation Agreement (Pre-Reform Act Case ­ Secured Debt) UNITED STATES BANKRUPTCY COURT DISTRICT OF SOUTH DAKOTA

In re: JANE A. ANONYMOUS, f/d/b/a Anne's Pottes `n Pannes,1 Debtor.

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Bankr. Case No. 04-10000 Chapter 7 REAFFIRMATION AGREEMENT AND DECLARATION OF ATTORNEY (SECURED DEBT)2

1. Debtor Jane A. Anonymous and Creditor Eighth National Bank agree that Debtor reaffirms the debt she owes to Creditor.3 2. This debt is secured by a lien against Debtor's 1975 AMC Gremlin. Debtor and Creditor agree this property is worth $1,550.00. 3. Debtor agrees to pay Creditor principal of $1,550.004 and interest at the rate of 12% per year. Interest will begin to accrue on September 1, 2004. Debtor will make 36 monthly payments of $51.50, for a total of $1,854.00. Debtor's first payment will be due on October 1, 2004.5 The principal amount does not include any attorney fees or other costs incurred by the Creditor.6 4. The parties' original note and security agreement dated April 1, 2003 are: 9 unchanged. : changed as follows: The amount owed has been reduced to the value of the collateral. The monthly payment has been reduced by $49.50. The term has been extended 12 months. 5. This agreement may be rescinded at any time prior to discharge or within 60 days after it is filed with the Court, whichever occurs later, by giving written notice of rescission to Creditor at the address set forth below. 6. Reaffirmation of this debt is not required under the Bankruptcy Code, under nonbankruptcy law, or under any agreement not in accordance with the provisions of 11 U.S.C. § 524(c). Dated: September 4, 2004 _________________________ Jane A. Anonymous _________________________ Guy N.A. Greysoot Eighth National Bank

Dated: September 1, 2004

Appendix 39 (cont'd) DECLARATION OF ATTORNEY7 I declare under penalty of perjury that I have represented Debtor Jane A. Anonymous in connection with this agreement, that this agreement represents a fully informed and voluntary agreement by Debtor, that this agreement does not impose an undue hardship on Debtor or a dependent of Debtor, and that I have fully advised Debtor of the legal effect and consequences of this agreement and any default under it.

Dated: September 4, 2004

_________________________ Joseph J. Jones, Esq. 101 E. Legal Lane Justice, SD 57000-0000 Tele: 605/555-5555 Fax: 605/555-5556

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