VOID CORRECTED

CREDITOR’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-1424

Cancellation

of Debt

2 Amount of debt canceled

1 Date canceled

CREDITOR’S federal identification number DEBTOR’S identification number

$

4 Debt description

5

DEBTOR’S name

Street address (including apt. no.) Was borrower personally liable for repayment of the debt?

City, state, and ZIP code

Account number (see instructions)

Form 1099-C Department of the Treasury - Internal Revenue Service

8585

Cat. No. 26280W

6

Form 1099-C

Check for bankruptcy 7 Fair market value of property

$

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

Copy A

For

Internal Revenue

Service Center

File with Form 1096.

For Privacy Act and

Paperwork Reduction

Act Notice, see the

2009 General

Instructions for 

Forms 1099, 1098,

3921, 3922, 5498,

and W-2G.

2009

3 Interest if included in box 2

Yes No

$
CORRECTED (if checked)

CREDITOR’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-1424

Cancellation

of Debt

CREDITOR’S federal identification number DEBTOR’S identification number

DEBTOR’S name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form 1099-C Department of the Treasury - Internal Revenue Service

Copy B

For Debtor

This is important tax

information and is being

furnished to the Internal

Revenue Service. If you

are required to file a

return, a negligence

penalty or other

sanction may be

imposed on you if

taxable income results

from this transaction

and the IRS determines

that it has not been

reported.

(keep for your records)

Form 1099-C

6 7 Bankruptcy (if checked) Fair market value of property

$

2009 2 Amount of debt canceled

1 Date canceled

$

4 Debt description

5 Was borrower personally liable for repayment of the debt?

3 Interest if included in box 2

Yes No

$
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 indebtedness, 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, Reduction of Tax Attributes Due to Discharge of

Indebtedness (and Section 1082 Basis Adjustment).

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 6. If the box is marked, the creditor has indicated the debt was

canceled in a bankruptcy proceeding.

Box 4. Shows a description of the debt. If box 7 is completed, box 4

shows a description of the property.

Box 3. Shows interest if included in the canceled debt in box 2. See Pub.

525, Taxable and Nontaxable Income, to see if you must include the

interest in gross income.

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, Acquisition or Abandonment of Secured Property.

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. If the

property was your main home, see Pub. 523, Selling Your Home, to

figure any taxable gain or ordinary income. See Pub. 4681, for

information about foreclosures and abandonments.

Account number. May show an account or other unique number the

creditor assigned to distinguish your account. Note. You may not have to include in income all or a portion of certain

qualified principal residence indebtedness canceled in 2009. See Pub.

4681, Canceled Debts, Foreclosures, Repossessions, and Abandonments

(for individuals), for more information.

Box 5. Shows whether borrower is personally liable for repayment of the

debt. See Pub. 4681 for reporting instructions.
VOID CORRECTED

CREDITOR’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-1424

Cancellation

of Debt

CREDITOR’S federal identification number DEBTOR’S identification number

DEBTOR’S name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form 1099-C Department of the Treasury - Internal Revenue Service

Form 1099-C

6 7 Check for bankruptcy Fair market value of property

$

For Creditor

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2009 General

Instructions for

Forms 1099,

1098, 3921, 3922,

5498, and W-2G.

Copy C

2009 2 Amount of debt canceled

1 Date canceled

$

4 Debt description

5 Was borrower personally liable for repayment of the debt?

3 Interest if included in box 2

Yes No

$
Instructions for Creditors

General and specific form instructions are provided as

separate products. The products you should use to

complete Form 1099-C are the 2009 General

Instructions for Forms 1099, 1098, 3921, 3922, 5498,

and W-2G and the 2009 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 the IRS website at www.irs.gov

or call 1-800-TAX-FORM (1-800-829-3676).

Due dates. Furnish Copy B of this form to the debtor

by February 1, 2010.

File Copy A of this form with the IRS by March 1,

2010. If you file electronically, the due date is March

31, 2010. To file electronically, you must have software

that generates a file according to the specifications in

Pub. 1220, Specifications for Filing Forms 1098, 1099,

3921, 3922, 5498, and W-2G Electronically. IRS does

not provide a fill-in form option.

Caution: Because paper forms are scanned during

processing, you cannot file Forms 1096, 1098, 1099,

3921, 3922, or 5498 that you print from the IRS

website.

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 304-267-3367 (not toll free).