DEBT REAFFIRMATION



DEBT REAFFIRMATION

FOR GOOD AND VALUABLE CONSIDERATION received, the undersigned hereby reaffirms to __________________________________(Creditor) and its successors and assigns, a certain prior debt discharged, released, extinguished or cancelled pursuant to _________________________________________ (reason for discharge), and that the undersigned shall be, and agrees to remain bound on said debt in the amount of exactly

$ ____________________, and to the same extent as if said debt were not discharged in the first instance.

It is further agreed that the above reaffirmed debt shall be paid as follows:

(State Payment Terms Here)

If said debt was discharged pursuant to any provision of the United States Bankruptcy Code, then this reaffirmation shall be subject to approval by the United States Bankruptcy Court, and that the undersigned shall diligently make application for said approval.

This agreement shall be binding upon the parties, their successors, assigns and personal representatives.

Signed this day _____ of ____________________, 2006.

_____________________________________________

Debtor

In the presence of:

_____________________________________________

Witness

_____________________________________________

Witness

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