CREDITOR’S federal identification number DEBTOR’S identification number

$

4 Debt description

5

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 RCat. No. 26280W

6

Form 1099-C

Check for bankruptcy 7 Fair market value of property

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Check here if the debtor was personally liable for

repayment of the 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)

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

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4 Debt description

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If checked, the debtor was personally liable for

repayment of the debt 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.

Box 1. Shows the date the debt was canceled.

Box 6. If the box is marked, the creditor has indicated the 

canceled in a bankruptcy proceeding.

Box 7. If, in the same calendar year, a foreclosure or aband

property occurred in connection with the cancellation of the 

market value (FMV) of the property will be shown, or you w

separate Form 1099-A. Generally, the gross foreclosure bid 

considered to be the FMV. For an abandonment or volunta

in lieu of foreclosure, the FMV is generally the appraised va

property. You may have income or loss because of the acq

abandonment. See Pub. 4681 for information about foreclo

abandonments. If the property was your main home, see P

figure any taxable gain or ordinary income.

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

creditor assigned to distinguish your account.

Box 5. Shows whether you were personally liable for repay

debt when the debt was created or, if modified, at the time 

modification. See Pub. 4681 for reporting instructions.
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 R

6 7 Check for bankruptcy Fair market value of property

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4 Debt description

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Check here if the debtor was personally liable for

repayment of the debt 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).

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

by January 31, 2012.

1099, 3921, 3922, 5498, 8935, and W-2G

Electronically. IRS does not provide a fill-in f

option.

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.

Need help? If you have questions about rep

Form 1099-C, call the information reporting c

service site toll free at 1-866-455-7438 or

304-263-8700 (not toll free). For TTY/TDD eq

call 304-579-4827 (not toll free). The hours o

are Monday through Friday from 8:30 a.m. to 

p.m., Eastern time.