VOID CORRECTED

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

Cancellation

of Debt

CREDITOR’S federal identification number DEBTOR’S identification number 1 Date canceled 2 Amount of debt canceled

$

3 Interest if included in box 2

5

DEBTOR’S name

Street address (including apt. no.) Debt description

City, state, and ZIP code

Account number (see instructions)

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

8585

Cat. No. 26280W

6

$

4

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

2005 General

Instructions for

Forms 1099, 1098,

5498, and W-2G.

2005
CORRECTED (if checked)

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

Cancellation

of Debt

CREDITOR’S federal identification number DEBTOR’S identification number 1 Date canceled 2 Amount of debt canceled

$

3 Interest if included in box 2

5

DEBTOR’S name

Street address (including apt. no.) Debt description

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)

4

$

Form 1099-C

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

$

2005
Instructions for Debtor

Note. You may not have to include in income a canceled debt (for

example, cancellation of a mortgage) if you are an individual who suffered

an economic loss by reason of Hurricane Katrina. You must be an

individual whose principal residence was in the Hurricane Katrina disaster

area on August 25, 2005. This relief applies to discharges made on or

after August 25, 2005, and before January 1, 2007. For more details, see

Pub. 4492, Tax Information Related to Hurricane Katrina, and the

instructions below for canceled debt not included in income.

However, some canceled debts are not includible in your income, such

as certain student loans (see Pub. 525), certain debts reduced by the

seller after purchase (see Pub. 334), qualified farm debt (see Pub. 225),

qualified real property business debt (see Pub. 334), or debts canceled in

bankruptcy (see Pub. 908). 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. If you exclude a canceled debt

Box 1. Shows the date the debt was canceled.

Box 2. Shows the amount of debt canceled.

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

canceled in a bankruptcy proceeding.

Box 5. Shows a description of the debt. If box 7 is completed, box 5

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 of the property will be shown, or you will receive a separate

Form 1099-A, Acquisition or Abandonment of Secured Property. You may

have income or loss because of the acquisition or abandonment. See

Pub. 544, Sales and Other Dispositions of Assets, for information about

foreclosures and abandonments.

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

creditor assigned to distinguish your account.

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 the canceled amount 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 instructions for your

tax return.

from your income because it was canceled in a bankruptcy case or

during insolvency, because the debt is qualified farm debt or qualified

real property business debt, or debt canceled due to Hurricane Katrina

file Form 982, Reduction of Tax Attributes Due to Discharge of

Indebtedness (and Section 1082 Basis Adjustment).
VOID CORRECTED

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

Cancellation

of Debt

CREDITOR’S federal identification number DEBTOR’S identification number 1 Date canceled 2 Amount of debt canceled

$

3 Interest if included in box 2

5

DEBTOR’S name

Street address (including apt. no.) Debt description

City, state, and ZIP code

Account number (see instructions)

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

$

4

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

2005 General

Instructions for

Forms 1099,

1098, 5498,

and W-2G.

Copy C

2005
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 2005 General Instructions for Forms

1099, 1098, 5498, and W-2G, and the 2005 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, call 1-800-TAX-FORM

(1-800-829-3676).

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

January 31, 2006.

File Copy A of this form with the IRS by February 28, 2006.

If you file electronically, the due date is March 31, 2006.

Printed on recycled paper

Caution: Because paper forms are scanned during

processing, you cannot file Forms 1096, 1098, 1099, or 5498

that you download and print from the IRS website.