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 RCat. No. 26280W

6

Form 1099-C

Check for bankruptcy 7 Fair market value of property

$

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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

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

$

4 Debt description

5 Was borrower personally liable for repayment of the debt?

Yes No

$ Form 1099-C
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.

with this amount, contact your creditor.

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

canceled in a bankruptcy proceeding.

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

shows a description of the property.

Box 3. Shows interest if included in the canceled debt in b

525, to see if you must include the interest in gross income

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. If the property was your main home, see Pu

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

about foreclosures and abandonments.

Box 5. Shows whether borrower is personally liable for rep

debt. See Pub. 4681 for reporting instructions.

Debtor’s identification number. For your protection, this form may show

only the last four digits of your social security number (SSN), individual

taxpayer identification number (ITIN), or adoption taxpayer identification
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

5 Was borrower personally liable for repayment of the debt?

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$ Form 1099-C
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 January 31, 2011.

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

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 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.