CREDITOR'S name, street address, city, state and ZIP codefield has the following information
Birch Bank, 76 Spruce Lane, Treetown, KS 00000.
CREDITOR'S federal identification numberfield shows an identification number of
DEBTOR'S identification numberfield shows an identification number of
DEBTOR'S name, Street address (including apt. no.), and City, state, and ZIP codefields show
John and Mary Elm, 11 Siberian Street, Treetown, KS 00000.
Account number (see instructions)field shows
Amount of debt canceledshows
Home mortgage loan.
Fair market value of propertyshows