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

The “CREDITOR'S name, street address, city, state and ZIP code” field has the following information “Bumble Bank, 5 Pollination Drive, Buzztown, NJ 07000.”

The “CREDITOR'S federal identification number ”field shows an identification number of “10-7654321.”

The “DEBTOR'S identification number ”field shows an identification number of “987-00-4321.”

The “DEBTOR'S name, Street address (including apt. no.), and City, state, and ZIP code” fields show “Frank and Kathy Willow, 21 Honeytree Lane, Apt. 5B, Buzztown, NJ 07000.”

The “Account number (see instructions)” box shows “5551212.”

Box 1, “Date canceled” shows “12-26-2007.”

Box 2, “Amount of debt canceled” shows “$750,000.00”.

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

Box 7, “Fair market value of property” shows “$1,750,000.00”.