2007 Form 1099-C, Cancellation of Debt. Summary: This is an example of Form 1099-C, Copy B, with the following items filled out:

The “CREDITOR'S name, street address, city, state and ZIP code” field has the following information “Birch Bank, 76 Spruce Lane, Treetown, MD 20008.”

The “CREDITOR'S federal identification number ”field shows an identification number of “10-7890123.”

The “DEBTOR'S identification number ”field shows an identification number of “234-00-7890.”

The “DEBTOR'S name, Street address (including apt. no.), and City, state, and ZIP code” fields show “John and Mary Elm, 11 Siberian Street, Treetown, MD 20008.”

The “Account number (see instructions)” field shows “505050.”

Box 1, “Date canceled” shows “3-1-2007.”

Box 2, “Amount of debt canceled” shows “$25,000.00”.

Box 5, “Debt description” shows “Home mortgage loan.”

Box, 7, “Fair market value of property” shows “$290,000.00”.