(a) (b) (c) (d) (e) Lender's name Personally Date of Balance Fair market liable ? acquisition outstanding Value (Box 5) (Box 1) (Box 2) (Box 4) Yes No EFTA01220513
(a) (b) (c) (d) (e) Lender's name Personally Date of Balance Fair market liable ? acquisition outstanding Value (Box 5) (Box 1) (Box 2) (Box 4) Yes No EFTA01220513