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Debt Re-affirmation

Complete the form below to generate a debt re-affirmation that you can print and use in the event you decide to re-affirm a debt that is dischargeable (normally by means of a bankruptcy).

Click here for completed sample. Bolded items are examples of completed fields from this form.

Debtor:
(Debtor's name)
Street Address:
(Debtor's street address)
City:
State:
(Select a state or a Canadian province)
Zip/Postal Code:
Country:
Creditor:
(Name of creditor company to whom debtor owes the debt)
Street Address:
(Creditor's Street Address)
City:
State:
(Select a state or a Canadian province)
Zip/Postal Code:
Country:
Attn:
(Name of person to whom you want to address the letter, if known.)
Debt Amount:
(Indicate amount of debt to be re-affirmed)
Discharged by:
(Indicate how the debt was discharged or otherwise extinguished - e.g., Chapt. 7 bankruptcy)
Debt to be Paid by:
(Detail how the debt will be paid. Press <ENTER> for each new line you want to start.)
Date Signed://
(Select the month, day and year you and your witness are signing the re-affirmation.)
Witness:
(Name of witness who will sign the re-affirmation)

This is not a substitute for legal advice and it is suggested that an attorney be consulted.

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