Form 1099-C Form 1099-C Cancellation of Debt

Attention:
This form is provided for informational purposes only. Copy A appears in red, similar to the
official IRS form. Do not file copy A downloaded from this website. The official printed
version of this IRS form is scannable, but the online version of it, printed from this website, is
not. A penalty may be imposed for filing forms that can’t be scanned. See part O in the
current General Instructions for Certain Information Returns for more information about
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See IRS Publications 1141, 1167, 1179 and other IRS resources for information about
printing these tax forms.

8585

VOID

CORRECTED

CREDITOR’S name, street address, city, state, ZIP code, and telephone no. 1 Date canceled

OMB No. 1545-1424

2011

2 Amount of debt canceled

Cancellation
of Debt

$
3 Interest if included in box 2
Form

$
CREDITOR’S federal identification number

1099-C

4 Debt description

DEBTOR’S identification number

Copy A
For
Internal Revenue
Service Center

DEBTOR’S name

File with Form 1096.
Street address (including apt. no.)

For Privacy Act and
Paperwork Reduction
Act Notice, see the
2011 General
Instructions for
Certain Information
7 Fair market value of property
Returns.

5 Check here if the debtor was personally liable for
repayment of the debt

City, state, and ZIP code

Account number (see instructions)

6 Check for bankruptcy

䊳

$
Form

1099-C

Cat. No. 26280W

Do Not Cut or Separate Forms on This Page

—

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

CORRECTED (if checked)
CREDITOR’S name, street address, city, state, ZIP code, and telephone no. 1 Date canceled
2 Amount of debt canceled

OMB No. 1545-1424

2011

$

Cancellation
of Debt

3 Interest if included in box 2

$
CREDITOR’S federal identification number

DEBTOR’S identification number

4 Debt description

Form

1099-C
Copy B
For Debtor

DEBTOR’S name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form

1099-C

This is important tax
information and is being
furnished to the Internal
Revenue Service. If you
are required to file a
5 If checked, the debtor was personally liable for
return, a negligence
penalty or other
repayment of the debt
䊳
sanction may be
imposed on you if
taxable income results
from this transaction
6 Bankruptcy (if checked)
7 Fair market value of property and the IRS determines
that it has not been
reported.
$

(keep for your records)

Department of the Treasury - Internal Revenue Service

Instructions for Debtor
If a Federal Government agency, certain agencies connected with the
Federal Government, financial institution, credit union, or an organization
having a significant trade or business of lending money (such as a
finance or credit card company) cancels or forgives a debt you owe of
$600 or more, this form must be provided to you. Generally, if you are an
individual, you must include all canceled amounts, even if less than $600,
on the “Other income” line of Form 1040. If you are a corporation,
partnership, or other entity, report the canceled debt on your tax return.
See the tax return instructions.
However, some canceled debts are not includible, or fully includible, in
your income, such as certain student loans, certain debts reduced by the
seller after purchase, qualified farm debt, qualified real property business
debt, qualified principal residence debt, or debts canceled in bankruptcy.
See Pub. 4681. Do not report a canceled debt as income if you did not
deduct it but would have been able to do so on your tax return if you had
paid it. Also, do not include canceled debts in your income to the extent
you were insolvent immediately before the cancellation of the debt. If you
exclude a canceled debt from your income, file Form 982.
Account number. May show an account or other unique number the
creditor assigned to distinguish your account.
Box 1. Shows the date the debt was canceled.

Box 2. Shows the amount of debt canceled. Note: If you do not agree
with this amount, contact your creditor.
Box 3. Shows interest if included in the canceled debt in box 2. See Pub.
4681 to see if you must include the interest in gross income.
Box 4. Shows a description of the debt. If box 7 is completed, box 4
shows a description of the property.
Box 5. Shows whether you were personally liable for repayment of the
debt when the debt was created or, if modified, at the time of the last
modification. See Pub. 4681 for reporting instructions.
Box 6. If the box is marked, the creditor has indicated the debt was
canceled in a bankruptcy proceeding.
Box 7. If, in the same calendar year, a foreclosure or abandonment of
property occurred in connection with the cancellation of the debt, the fair
market value (FMV) of the property will be shown, or you will receive a
separate Form 1099-A. Generally, the gross foreclosure bid price is
considered to be the FMV. For an abandonment or voluntary conveyance
in lieu of foreclosure, the FMV is generally the appraised value of the
property. You may have income or loss because of the acquisition or
abandonment. See Pub. 4681 for information about foreclosures and
abandonments. If the property was your main home, see Pub. 523 to
figure any taxable gain or ordinary income.

VOID

CORRECTED

CREDITOR’S name, street address, city, state, ZIP code, and telephone no. 1 Date canceled

OMB No. 1545-1424

2011

2 Amount of debt canceled

Cancellation
of Debt

$
3 Interest if included in box 2

$
CREDITOR’S federal identification number

DEBTOR’S identification number

Form

1099-C

4 Debt description

Copy C
For Creditor

DEBTOR’S name

Street address (including apt. no.)

5 Check here if the debtor was personally liable for
repayment of the debt

䊳

City, state, and ZIP code

Account number (see instructions)

6 Check for bankruptcy

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2011 General
Instructions for
Certain Information
Returns.

7 Fair market value of property

$
Form

1099-C

Department of the Treasury - Internal Revenue Service

Instructions for Creditor
General and specific form instructions are provided as
separate products. The products you should use to
complete Form 1099-C are the 2011 General
Instructions for Certain Information Returns and the
2011 Instructions for Forms 1099-A and 1099-C. A
chart in the general instructions gives a quick guide to
which form must be filed to report a particular
payment. To order these instructions and additional
forms, visit IRS.gov or call 1-800-TAX-FORM
(1-800-829-3676).
Caution: Because paper forms are scanned during
processing, you cannot file Forms 1096, 1097, 1098,
1099, 3921, 3922, or 5498 that you print from the IRS
website.
Due dates. Furnish Copy B of this form to the debtor
by January 31, 2012.

File Copy A of this form with the IRS by February 28,
2012. If you file electronically, the due date is April 2,
2012. To file electronically, you must have software
that generates a file according to the specifications in
Pub. 1220, Specifications for Filing Forms 1097, 1098,
1099, 3921, 3922, 5498, 8935, and W-2G
Electronically. IRS does not provide a fill-in form
option.
Need help? If you have questions about reporting on
Form 1099-C, call the information reporting customer
service site toll free at 1-866-455-7438 or
304-263-8700 (not toll free). For TTY/TDD equipment,
call 304-579-4827 (not toll free). The hours of operation
are Monday through Friday from 8:30 a.m. to 4:30
p.m., Eastern time.