Shown is Form 3245. Some fields are filled in as follows: SSN/TIN: 000-00-0001Return Period: 20XX12Master File Tax (MFT): 30Name: John DoeSchedule Date: 041620XX (Under Cancellation Column)Date Received: Blank (Under Repayment Column)Trans: 843 (Under Cancellation Column)Amt. of check: $121.30 (Under Cancellation Column)Trans: Blank (Under Repayment Column)Amt. of check: Blank (Under Repayment Column)Trans.: Blank (Under Repayment Column)Interest: Blank (Under Repayment Column)Check Number: 33335001Date: 100720XXSchedule Number: 7000001Prepared by (initials): JARRemarks: To reverse TC 841 per SF 1081
