DECLARATION FOR DEBTOR
UNITED STATES BANKRUPTCY COURT
FOR THE __________ DISTRICT OF __________
I, ________________________________, attorney
for _________________________ ___________________, debtor in the above-entitled
represented the debtor in the course of the attached reaffirmation agreement
between the debtor and ____________________________, a creditor in the amount
of ____________________ Dollars ($___________) pursuant to the provisions of
Section _______________ of the United States Bankruptcy Code.
clearly explained the attached reaffirmation agreement to the above-stated
debtor. __________ (He or She) is fully informed about the contents of the
agreement and has entered into the agreement voluntarily and of __________ (his
or her) own free will.
made inquiries of the debtor’s financial condition and, to the best of my knowledge,
information, and belief, the attached reaffirmation agreement will not impose
any undue hardship on the debtor or on a dependent of the debtor.
Under penalty of perjury, I, as declarant in the
above statement, declare that the statement is true and correct.