B2400A/B ALT (Form 2400A/B ALT) (12/15) G Presumption of Undue Hardship G No Presumption of Undue Hardship (Check box as directed in Part D: Debtor's Statement in Support of Reaffirmation Agreement) LOCAL BANKRUPTCY FORM 4008-1(a) IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : : CHAPTER ____ CASE NO. -bk- Debtor(s) REAFFIRMATION AGREEMENT [Indicate all documents included in this filing by checking each applicable box.] G Part A; Disclosures, Instructions, and Notice to Debtor (pages 1�5) G Part B: Reaffirmation Agreement G Part D: Debtor's Statement in Support of Reaffirmation Agreement G Part E: Motion for Court Approval G Part C: Certification by Debtor's Attorney [Note: Complete Part E only if debtor was not represented by an attorney during the course of negotiating this agreement. Note also: If you complete Part E, you must prepare and file Form 2400C ALT - Order on Reaffirmation Agreement.] Name of Creditor: _______________________________________________ G [Check this box if] Creditor is a Credit Union as defined in �19(b)(1)(a)(iv) of the Federal Reserve Act PART A: DISCLOSURE STATEMENT, INSTRUCTIONS AND NOTICE TO DEBTOR 1. DISCLOSURE STATEMENT Before Agreeing to Reaffirm a Debt, Review These Important Disclosures: SUMMARY OF REAFFIRMATION AGREEMENT This Summary is made pursuant to the requirements of the Bankruptcy Code. American LegalNet, Inc. www.FormsWorkFlow.com P.2 AMOUNT REAFFIRMED The amount of debt you have agreed to reaffirm $ The amount of debt you have agreed to reaffirm includes al fees and costs (if any) that have accrued as of the date of this disclosure. Your credit agreement may obligate you to pay additional amounts which may come due after the date of this disclosure. Consult your credit agreement. ANNUAL PERCENTAGE RATE [The annual percentage rate can be disclosed in different ways, depending on the type of debt.] a. If the debt is an extension of "credit" under an "open end credit plan," as those terms are defined in � 103 of the Truth in Lending Act, such as a credit card, the creditor may disclose the annual percentage rate shown in (i) below or, to the extent this rate is not readily available or not applicable, the simple interest rate shown in (ii) below, or both. (i) The Annual Percentage Rate disclosed, or that would have been disclosed, to the debtor in the most recent periodic statement prior to entering into the reaffirmation agreement described in Part B below or, if no such periodic statement was given to the debtor during the prior six months, the annual percentage rate as it would have been so disclosed at the time of the %. disclosure statement: � And/Or � (ii) The simple interest rate applicable to the amount reaffirmed as of the date this disclosure statement is given to the debtor: %. If different simple interest rates apply to different balances included in the amount reaffirmed, the amount of each balance and the rate applicable to it are: @ @ @ %; %; %; $ $ $ b. If the debt is an extension of credit other than under an open end credit plan, the creditor may disclose the annual percentage rate shown in (i) below, or, to the extent this rate is not readily available or not applicable, the simple interest rate shown in (ii) below, or both. American LegalNet, Inc. www.FormsWorkFlow.com P.3 (i) The Annual Percentage Rate under �128(a)(4) of the Truth in Lending Act, as disclosed to the debtor in the most recent disclosure statement given to the debtor prior to entering into the reaffirmation agreement with respect to the debt or, if no such disclosure statement was given to the debtor, the annual percentage rate as it would have been so disclosed: %. � And/Or � (ii) The simple interest rate applicable to the amount reaffirmed as of the date %. If different this disclosure statement is given to the debtor: simple interest rates apply to different balances included in the amount reaffirmed, the amount of each balance and the rate applicable to it are: $ @ %; $ @ %; $ @ %; c. If the underlying debt transaction was disclosed as a variable rate transaction on the most recent disclosure given under the Truth in Lending Act: The interest rate on your loan may be a variable interest rate which changes from time to time, so that the annual percentage rate disclosed here may be higher or lower. d. If the reaffirmed debt is secured by a security interest or lien, which has not been waived or determined to be void by a final order of the court, the following items or types of items on the debtor's goods or property remain subject to such security interest or lien in connection with the debt or debts being reaffirmed in the reaffirmation agreement described in Part B. Item or Type of Item Original Purchase Price or Original Amount of Loan Optional -- At the election of the creditor, a repayment schedule using one or a combination of the following may be provided: Repayment Schedule: Your first payment in the amount of $ is due on (date), but the future payment amount may be different. Consult your reaffirmation agreement or credit agreement, as applicable. American LegalNet, Inc. www.FormsWorkFlow.com P.4 - - - Or - - Your payment schedule will be: (number) payments in the amount of $ each, payable (monthly, annually, weekly, etc.) on the (day) of each (week, month, etc.), unless altered later by mutual agreement in writing. - - - Or - - A reasonably specific description of the debtor's repayment obligations to the extent known by the creditor or creditor's representative. 2. INSTRUCTIONS AND NOTICE TO DEBTOR Reaffirming a debt is a serious financial decision. The law requires you to take certain steps to make sure the decision is in your best interest. If these steps are not completed, the reaffirmation agreement is not effective, even though you have signed it. 1. Read the disclosures in this Part A carefully. Consider the decision to reaffirm carefully. Then, if you want to reaffirm, sign the reaffirmation agreement in Part B (or you may use a separate agreement you and your creditor agree on). 2. Complete and sign Part D and be sure you can afford to make the payments you are agreeing to make and have received a copy of the disclosure statement and a completed and signed reaffirmation agreement. 3. If you were represented by an attorney during the negotiation of your reaffirmation agreement, the attorney must have signed the certification in Part C. 4. If you were not represented by an attorn