Official Form 427 "Cover Sheet for Reaffirmation Agreement"

What Is Official Form 427?

This is a legal form that was released by the United States Bankruptcy Court on December 1, 2015 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2015;
  • The latest available edition released by the United States Bankruptcy Court;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Official Form 427 by clicking the link below or browse more documents and templates provided by the United States Bankruptcy Court.

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Fill in this information to identify your case:
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)
Official Form 427
Cover Sheet for Reaffirmation Agreement
12/15
Anyone who is a party to a reaffirmation agreement may fill out and 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. Who is the creditor?
Name of the creditor
2. How much is the debt?
On the date that the bankruptcy case is filed
$
To be paid under the reaffirmation agreement $
$
per month until paid in full
$
per month until paid in full
$
per month until paid in full
$
per month until paid in full
3. What is the Annual
Before the bankruptcy case was filed
%
Percentage Rate (APR)
of interest? (See
Bankruptcy Code
Under the reaffirmation agreement
%
Fixed rate
§ 524(k)(3)(E).)
Adjustable rate
What is the Annual
Before the bankruptcy case was filed
%
Percentage Rate (APR)
of interest? (See
Bankruptcy Code
Under the reaffirmation agreement
%
Fixed rate
§ 524(k)(3)(E).)
Adjustable rate
What is the Annual
Before the bankruptcy case was filed
%
Percentage Rate (APR)
of interest? (See
Bankruptcy Code
Under the reaffirmation agreement
%
Fixed rate
§ 524(k)(3)(E).)
Adjustable rate
What is the Annual
Before the bankruptcy case was filed
%
Percentage Rate (APR)
of interest? (See
Bankruptcy Code
Under the reaffirmation agreement
%
Fixed rate
§ 524(k)(3)(E).)
Adjustable rate
Official Form 427
Cover Sheet for Reaffirmation Agreement
page 1
Fill in this information to identify your case:
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)
Official Form 427
Cover Sheet for Reaffirmation Agreement
12/15
Anyone who is a party to a reaffirmation agreement may fill out and 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. Who is the creditor?
Name of the creditor
2. How much is the debt?
On the date that the bankruptcy case is filed
$
To be paid under the reaffirmation agreement $
$
per month until paid in full
$
per month until paid in full
$
per month until paid in full
$
per month until paid in full
3. What is the Annual
Before the bankruptcy case was filed
%
Percentage Rate (APR)
of interest? (See
Bankruptcy Code
Under the reaffirmation agreement
%
Fixed rate
§ 524(k)(3)(E).)
Adjustable rate
What is the Annual
Before the bankruptcy case was filed
%
Percentage Rate (APR)
of interest? (See
Bankruptcy Code
Under the reaffirmation agreement
%
Fixed rate
§ 524(k)(3)(E).)
Adjustable rate
What is the Annual
Before the bankruptcy case was filed
%
Percentage Rate (APR)
of interest? (See
Bankruptcy Code
Under the reaffirmation agreement
%
Fixed rate
§ 524(k)(3)(E).)
Adjustable rate
What is the Annual
Before the bankruptcy case was filed
%
Percentage Rate (APR)
of interest? (See
Bankruptcy Code
Under the reaffirmation agreement
%
Fixed rate
§ 524(k)(3)(E).)
Adjustable rate
Official Form 427
Cover Sheet for Reaffirmation Agreement
page 1
4. Does collateral secure
No
the debt?
Yes. Describe the collateral.
________________________________________________________________
Current market value
$
5. Does the creditor assert
No
that the debt is
nondischargeable?
Yes. Attach an explanation of the nature of the debt and the basis for contending that the debt is nondischargeable.
6. Using information from
Income and expenses reported on Schedules I and J
Income and expenses stated on the reaffirmation agreement
Schedule I: Your Income
(Official Form 106I) and
6e. Monthly income from all sources
$
6a. Combined monthly income from
$
Schedule J: Your
after payroll deductions
line 12 of Schedule I
Expenses (Official Form
6f. Monthly expenses
106J), fill in the amounts.
$
6g. Monthly payments on all
$
6b. Monthly expenses from line 22c of
$
reaffirmed debts not included in
Schedule J
monthly expenses
6h. Present net monthly income
$
6c. Monthly payments on all
$
Subtract lines 6f and 6g from 6e.
reaffirmed debts not listed on
If the total is less than 0, put the
Schedule J
number in brackets.
6d. Scheduled net monthly income
$
Subtract lines 6b and 6c from 6a.
If the total is less than 0, put the
number in brackets.
Debtor 1
_________________________________________________________
Case number
(if known)_____________________________________________________________
First Name
Middle Name
Last Name
Debtor 2
_________________________________________________________
First Name
Middle Name
Last Name
7. Are the income amounts
No
on lines 6a and 6e
Yes. Explain why they are different and complete line 10.
different?
_____________________________________________________________________________________
No
8. Are the expense
amounts on lines 6b
Yes. Explain why they are different and complete line 10.
and 6f different?
_______________________________________________________________________________________
9. Is the net monthly
No
income in line 6h less
Yes. A presumption of hardship arises (unless the creditor is a credit union).
than 0?
Explain how the debtor will make monthly payments on the reaffirmed debt and pay other living expenses.
Complete line 10.
______________________________________________________________________________________
______________________________________________________________________________________
Official Form 427
Cover Sheet for Reaffirmation Agreement
page 2
10. Debtor’s certification
I certify that each explanation on lines 7-9 is true and correct.
about lines 7-9
If any answer on lines 7-9 is
Yes, the debtor must sign
here.
_______________________________________
_______________________________________
If all the answers on lines 7-9
Signature of Debtor 1
Signature of Debtor 2 (Spouse Only in a Joint Case)
are No, go to line 11.
No
11. Did an attorney represent
the debtor in negotiating
Yes. Has the attorney executed a declaration or an affidavit to support the reaffirmation agreement?
the reaffirmation
No
agreement?
Yes
Part 2:
Sign Here
Whoever fills out this form I certify that the attached agreement is a true and correct copy of the reaffirmation agreement between the
must sign here.
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
Official Form 427
Cover Sheet for Reaffirmation Agreement
page 3
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