Official Form 427, Cover Sheet for Reaffirmation Agreement
The usage of this Judicial Conference-approved bankruptcy form is limited to cases under Bankruptcy Rule 9009. Functioning as a cover sheet, the completed version of this form must be attached to the reaffirmation agreement prior submission. As for the schedule of the filing, applicant is encouraged to inquire from the US Bankruptcy Court.Download
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Official Form 427Cover Sheet for Reaffirmation Agreement page 1Official Form 427 Cover Sheet for Rea ffirmation Agreement 12/15 Anyone who is a party to a reaffirmation agreement may fill out an d file this form. Fill it out completely, attach it to the reaffirmation agreement, and file the documents within the time set under Bankruptcy Rule 4008. Part 1: Explain the Repayment Terms of the Reaffirmation Agreement 1. W ho is the cred itor? ____ ______________________________________________________________________________________________________ Name of the creditor 2. Ho w much is the debt? On the date that the bankruptcy case is filed $__________________ To be paid under the reaffirmation agreement $__________________ $________ per month for ______ months (if fixed interest rate) 3. What is the Annu al Pe rcentage Rate (APR ) of in terest? (See Bankruptcy Co de § 524(k )(3)(E).) Before the bankruptcy case was filed __________________% Under the reaffirmation agreement __________________% Fixed rate Adjustable rate 4. Does c ollateral secure t he debt ? No Yes. Describe the collatera l. ____ ____________________________________________________________________ Current market value $__________________ 5. Does t he credit or assert that the de bt is non dischargeable? No Yes. Attach an explanation of the nature of the debt and the basis for contending that the debt is nondischargeable. 6. Using i nformation fr om Sched ule I: Your Income (Official Form 106I) an d Sched ule J: Yo ur Expense s (Official Form 106J) , fill i n the amounts. Income and expenses repor ted on Schedules I and J Income and expenses stated on the reaffirmation agreement 6a. Combined monthly income from line 12 of Schedule I $ _____________ 6e. Monthly income from all sources after payroll deductions $ ______________ 6b. Monthly expenses from line 22c o f Schedule J – $ ___________ 6f. Monthl y expenses – $ ______________ 6c. Monthly payments on all reaffirmed debts not listed on Schedule J – $ ___________ 6g. Monthly payments on all reaffirmed debts not included in monthly expenses – $ ______________ 6d. Scheduled net monthly income Subtract lines 6b and 6c from 6a. If the total is less than 0, put the number in brackets. $ ____________ 6h. Present net monthly income Subtract lines 6f and 6g from 6e. If the total is less than 0, put the number in brackets. $ ______________ Debtor 1 __________________________________________________________________ First Name Middle Name Last Name Debtor 2 ________________________________________________________________ (Spouse, if filing) First Name Middle Name Last Name United States Bankruptcy Court for the: __________ District of __________ Case number ___________________________________________ (If known) Fill in this information to identify your case: Debtor 1 _______________________________________________________ Case number (if known ) _____________________________________ First Name Middle Name Last Name Official Form 427 Cover Sheet for Reaffirmation Agreement page 2 7. Are the income amounts on lines 6a and 6e different? No Yes. Explain why they are different and complete line 10._____________________________________________ ______________________________________________________________________________________ 8. A re the expenseamounts on lines 6b and 6 f different ? No Yes. Explain why they are different and complete line 10.______________________________________________ ______________________________________________________________________________________ 9. Is the net monthlyincome in line 6h less than 0? No Yes. A presumption of hardship arises ( unless the creditor is a credit union). Ex plain how the debtor will make monthly payments on the reaffirmed debt and pay other living expenses. Complete line 10. ______________________________________________________________________________________ ______________________________________________________________________________________ 10. Debt or’s certification about lines 7-9 If any answer on lines 7-9 is Yes, the debtor must sign here. I f all the answers on lines 7-9 are No, go to line 11. I certif y that each explanation on lines 7-9 is true and correct. ________________________________________ Signature of Debtor 1 ___________________________ Signature of Debtor 2 (Spouse Only in a Joint Case) 11. Did an attorney represen t the d ebtor in negotiating the reaffirmatio n agreeme nt? No Yes. Has the attorney executed a declaration or an affidavit to support the reaffirmation agreement? No Yes Part 2: Sign Here Whoever fills out this form must sign here. I 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 . _____________________________________________________________ Date _________________ Signature MM / DD / YYYY _____________________________________________________________________ Printed Name Check one: Debtor or Debtor’s Attorney Creditor or Creditor’s Attorney
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