COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : : Plaintiff(s) Calendar No. (Rev. 1-12-95) JUDICIAL SUBPOENA CLF 162 IN THE UNITED STATES BANKRUPTCY COURT FOR THE NORTHERN DISTRICT OF MISSISSIPPI : -againstIN RE: CASE NO.: : : REAFFIRMATION AGREEMENT Defendant(s) : ...................................................... Debtor(s) and Creditor hereby enter into this reaffirmation agreement as to the herein described debt, which is dischargeable under Chapter 7 of Title 11 of the United States Code. NAME & ADDRESS OF SECURITY THE CREDITOR OF THE STATE OF NEW YORK PEOPLE REAFFIRMATION AMOUNT PERIODIC PAYMENT TO In consideration of the new promise by debtor(s) hereby reaffirmed to pay said debt and the retention by debtor(s) of the subject security, this agreement is hereby made after notice to the Debtor(s) as follows: GREETINGS: NOTICE TO WE COMMAND YOU, that all business and DEBTOR(S) excuses being laid aside, you and each of you attend before , the Honorable at the Court THIS UNDER NONBANKRUPTCY at CountyAGREEMENT IS NOT REQUIREDlocated THE BANKRUPTCY CODE, UNDEROF 11 U.S.C. § LAW OR UNDER ANY of OTHER AGREEMENT WHICH IS NOT IN ACCORDANCE WITH THE PROVISIONS 524(C). THIS RESCINDED ATday of ANY TIME PRIOR TO20 SUCH AGREEMENT inAGREEMENT MAY BE, on the room , DISCHARGE OR WITHIN 60 in theAFTER noon, and at any recessed , at o'clock DAYS IS FILED WITH THE COURT, WHICHEVER OCCURS LATER, BY GIVING NOTICE OF RESCISSION TO THE orAFOREMENTIONED SECURED CREDITOR. evidence as a witness in this action on the part of the adjourned date, to testify and give DECLARATION OF ATTORNEY I, attorney for punishable as a contempt of court and will make Your failure to comply with,this subpoena isDebtor(s), do hereby declare or affirm that I you liable to represented the Debtor(s) during the course of negotiating this reaffirmation agreement and that: the party on whose behalf this subpoenaof the legalfor a maximum penalty of $50entering damages sustained as a 1. I fully advised the Debtor(s) was issued effect and consequences of and all into this reaffirmation agreement and result of your failure to comply. of the legal effect and consequences of any default under this reaffirmation agreement. 2. This reaffirmation agreement represents a fully informed and voluntary agreement by the Debtor(s) and does not impose an undue hardship on the Debtor(s) or a dependent of the Debtor(s). Witness, Honorable Court in County, MADE this the , one of the Justices of the Day of day of , 20 , . ATTORNEY FOR DEBTOR(S) (Attorney must sign above and type name below) DEBTOR CREDITOR Attorney(s) for DEBTOR ATTACHED IS A CLEAR COPY OF EACH PERTINENT UCC OR OTHER SECURITY DOCUMENT FORMING THE BASIS OF Office and P.O. Address THIS REAFFIRMATION AGREEMENT. ATTORNEY FOR DEBTOR(S) Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com