Form 1099-C

2012

Cat. No. 26280W

Cancellation 

of Debt

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096. 

OMB No. 1545-1424

For Privacy Act and 

Paperwork Reduction 

Act Notice, see the 

2012 General 

Instructions for 

Certain Information 

Returns.

8585 VOID CORRECTED

CREDITOR'S name, street address, city, state, ZIP code, and telephone no.

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)

1 Date of identifiable event

2 Amount of debt discharged

$

3 Interest if included in box 2

$

4 Debt description

5 Check here if the debtor was personally liable for 

repayment of the debt . . . . . . . a

6 Identifiable event code 7 Fair market value of property

$

Form 1099-C

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
Form 1099-C

2012 Cancellation 

of Debt

Copy B

For Debtor

Department of the Treasury - Internal Revenue Service

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.

OMB No. 1545-1424

CORRECTED (if checked)

CREDITOR'S name, street address, city, state, ZIP code, and telephone no.

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)

1 Date of identifiable event

2 Amount of debt discharged

$

3 Interest if included in box 2

$

4 Debt description

5 If checked, the debtor was personally liable for 

repayment of the debt . . . . . . . a

6 Identifiable event code 7 Fair market value of property

$

Form 1099-C (keep for your records)
Instructions for Debtor

You received this form because a Federal Government agency or an applicable 

financial entity (a lender) has discharged (canceled or forgiven) a debt you owed, 

or because an identifiable event has occurred that either is or is deemed to be a 

discharge of a debt of $600 or more. If a creditor has discharged a debt you 

owed, you are required to include the discharged amount in your income, even if 

it is less than $600, on the "Other income" line of your Form 1040. However, you 

may not have to include all of the canceled debt in your income. There are 

exceptions and exclusions, such as bankruptcy and insolvency. See Pub. 4681, 

available at IRS.gov, for more details. If an identifiable event has occurred but 

the debt has not actually been discharged, then include any discharged debt in 

your income in the year that it is actually discharged, unless an exception or 

exclusion applies to you in that year. 

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

the last four digits of your SSN, ITIN, or ATIN. However, the issuer has reported 

your complete identification number to the IRS, and, where applicable, to state 

and/or local governments.

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

assigned to distinguish your account. 

Box 1. Shows the date the earliest identifiable event occurred or, at the 

creditor's discretion, the date of an actual discharge that occurred before an 

identifiable event. See the code in box 6. 

Box 2. Shows the amount of debt either actually or deemed discharged. Note. If 

you do not agree with the amount, contact your creditor. 

Box 4. Shows a description of the debt. If box 7 is completed, box 4 also 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. May show the reason your creditor has filed this form. The codes in this 

box are described in more detail in Pub. 4681. A—Bankruptcy; B—Other 

judicial debt relief; C—Statute of limitations or expiration of deficiency period; D

—Foreclosure election; E—Debt relief from probate or similar proceeding; F—By 

agreement; G—Decision or policy to discontinue collection; H—Expiration of 

nonpayment testing period; or I—Other actual discharge before identifiable 

event. 

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.

Box 3. Shows interest if included in the debt reported in box 2. See Pub. 4681 

to see if you must include the interest in gross income.

Future developments. The IRS has created a page on IRS.gov for information 

about Form 1099-C and its instructions, at www.irs.gov/form1099c. Information 

about any future developments affecting Form 1099-C (such as legislation 

enacted after we release it) will be posted on that page. 
Form 1099-C

2012 Cancellation 

of Debt

Copy C

For Creditor

Department of the Treasury - Internal Revenue Service

OMB No. 1545-1424

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

2012 General 

Instructions for 

Certain Information 

Returns.

VOID CORRECTED

CREDITOR'S name, street address, city, state, ZIP code, and telephone no.

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)

1 Date of identifiable event

2 Amount of debt discharged

$

3 Interest if included in box 2

$

4 Debt description

5 Check here if the debtor was personally liable for 

repayment of the debt . . . . . . . a

6 Identifiable event code 7 Fair market value of property

$

Form 1099-C
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 2012 General 

Instructions for Certain Information Returns and the 

2012 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, 2013.

File Copy A of this form with the IRS by February 28, 

2013. If you file electronically, the due date is April 1, 

2013. 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.

Future developments. The IRS has created a page on 

IRS.gov for information about Form 1099-C and its 

instructions, at www.irs.gov/form1099c. Information 

about any future developments affecting Form 1099-C 

(such as legislation enacted after we release it) will be 

posted on that page.