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 included in box 2

5

DEBTOR’S name

Street address (including apt. no.) Debt description

City, state, and ZIP code

Account number (optional)

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

8585

Copy A

For Paperwork

Reduction Act

Notice and

instructions for

completing this form,

see Instructions for

Forms 1099, 1098,

5498, and W-2G.

File with Form 1096.

Do NOT Cut or Separate Forms on This Page

Cat. No. 26280W

For

Internal Revenue

Service Center

6 Check here if the debt was discharged

in bankruptcy ©

$ $

Penalties, fines, admin.

costs included in box 2

4

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 included in box 2

5

DEBTOR’S name

Street address (including apt. no.) Debt description

City, state, and ZIP code

Account number (optional)

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

6 Debt was discharged in bankruptcy

(if checked) ©

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.)

Penalties, fines, admin.

costs included in box 2

4

$ $
Instructions for Debtor

If a Federal Government agency, financial institution, or credit

union 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 in your

income on 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.

However, some canceled debts, such as certain student

loans, qualified farm debt, qualified real property business

debt, or debts canceled in bankruptcy, are not includible in

your income. 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 canceled debt from your income because it was

canceled in a bankruptcy case or during insolvency, or

because the debt is qualified farm debt or qualified real

Box 1.—Shows the date the debt was canceled.

Box 2.—Shows the amount of debt canceled, including

principal, interest, penalties, fines, and administrative costs.

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.

Box 3.—Shows the amount of interest included in the

canceled debt in box 2.

Box 4.—Shows penalties, fines, or administrative costs

included in box 2 as part of the canceled debt.

property business debt, file Form 982, Reduction of Tax

Attributes Due to Discharge of Indebtedness (and Section

1082 Basis Adjustment). See Pub. 908, which deals with

bankruptcy and other debt cancellation, for details.
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 included in box 2

5

DEBTOR’S name

Street address (including apt. no.) Debt description

City, state, and ZIP code

Account number (optional)

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

6 Check here if the debt was discharged

in bankruptcy ©

Copy C

For Creditor

For Paperwork

Reduction Act

Notice and

instructions for

completing this

form, see

Instructions for

Forms 1099,

1098, 5498,

and W-2G.

$ $

Penalties, fines, admin.

costs included in box 2

4
Creditors, Please Note—

Specific information needed to complete this form and other

forms in the 1099 series is given in the Instructions for

Forms 1099, 1098, 5498, and W-2G. A chart in those

instructions gives a quick guide to which form must be filed

to report a particular payment. You can order those

instructions and additional forms by calling 1-800-TAX-FORM

(1-800-829-3676).

Furnish Copy B of this form to the debtor by January 31,

1995.

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

1995.

Printed on recycled paper