Form 1099-C Cancellation of Debt

Attention:
Copy A of this form is provided for informational purposes only. Copy A appears in red,
similar to the official IRS form. The official printed version of Copy A of this IRS form is
scannable, but the online version of it, printed from this website, is not. Do not print and file
copy A downloaded from this website; a penalty may be imposed for filing with the IRS
information return forms that can’t be scanned. See part O in the current General
Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more
information about penalties.
Please note that Copy B and other copies of this form, which appear in black, may be
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forms.

8585

VOID

CORRECTED

CREDITOR'S name, street address, city or town, state or province, country,
ZIP or foreign postal code, and telephone no.

1 Date of identifiable event
2 Amount of debt discharged

$
3 Interest, if included in box 2

$
CREDITOR'S TIN

DEBTOR'S TIN

OMB No. 1545-1424

2021
Form 1099-C

Copy A

4 Debt description

For
Internal Revenue
Service Center

DEBTOR'S name

Street address (including apt. no.)

File with Form 1096.
For Privacy Act and
. ▶
Paperwork Reduction
Act Notice, see the
2021 General
Instructions for
7 Fair market value of property Certain Information
Returns.
$

5 Check here if the debtor was personally liable for
repayment of the debt . . . . . . .

City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)

Cancellation
of Debt

6 Identifiable event code

1099-C
Cat. No. 26280W
www.irs.gov/Form1099C
Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

Form

CORRECTED (if checked)
CREDITOR'S name, street address, city or town, state or province, country,
ZIP or foreign postal code, and telephone no.

1 Date of identifiable event
2 Amount of debt discharged

$
3 Interest, if included in box 2

OMB No. 1545-1424

2021
Form 1099-C

$
CREDITOR'S TIN

DEBTOR'S TIN

Cancellation
of Debt
Copy B

4 Debt description

For Debtor
DEBTOR'S name

Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)

This is important tax
information and is being
furnished to the IRS. If
you are required to file a
return, a negligence
5 If checked, the debtor was personally liable for
penalty or other
repayment of the debt . . . . . . . . ▶
sanction may be
imposed on you if
taxable income results
from this transaction
and the IRS determines
6 Identifiable event code
7 Fair market value of property
that it has not been
reported.

$

Form

1099-C

(keep for your records)

www.irs.gov/Form1099C

Department of the Treasury - Internal Revenue Service

Instructions for Debtor

You received this form because a federal government agency or an applicable
financial entity (a creditor) 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 or
1040-SR. 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 taxpayer identification number (TIN). For your protection, this form
may show only the last four digits of your TIN (social security number (SSN),
individual taxpayer identification number (ITIN), adoption taxpayer identification
number (ATIN), or employer identification number (EIN)). However, the creditor
has reported your complete TIN to the IRS.
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 don't agree with the amount, contact your creditor.
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.

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. Shows 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; or H—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.
Future developments. For the latest information about developments related to
Form 1099-C and its instructions, such as legislation enacted after they were
published, go to www.irs.gov/Form1099C.
FreeFile. Go to www.IRS.gov/FreeFile to see if you qualify for no-cost online
federal tax preparation, e-filing, and direct deposit or payment options.

VOID

CORRECTED

CREDITOR'S name, street address, city or town, state or province, country,
ZIP or foreign postal code, and telephone no.

1 Date of identifiable event
2 Amount of debt discharged

$
3 Interest, if included in box 2

OMB No. 1545-1424

2021
Form 1099-C

$
CREDITOR'S TIN

DEBTOR'S TIN

Cancellation
of Debt
Copy C

4 Debt description

For Creditor
DEBTOR'S name

Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)

For Privacy Act
and Paperwork
Reduction Act
5 Check here if the debtor was personally liable for
Notice, see the
repayment of the debt . . . . . . . . ▶
2021 General
Instructions for
Certain Information
Returns.
6 Identifiable event code
7 Fair market value of property

$
Form

1099-C

www.irs.gov/Form1099C

Department of the Treasury - Internal Revenue Service

Instructions for Creditor
To complete Form 1099-C, use:
• The 2021 General Instructions for Certain Information
Returns, and
• The 2021 Instructions for Forms 1099-A and 1099-C.
To order these instructions and additional forms, go
to www.irs.gov/Form1099C.
Caution: Because paper forms are scanned during
processing, you cannot file Forms 1096, 1097, 1098,
1099, 3921, or 5498 that you print from the IRS website.
Due dates. Furnish Copy B of this form to the debtor by
January 31, 2022.

File Copy A of this form with the IRS by February 28,
2022. If you file electronically, the due date is March 31,
2022. To file electronically, you must have software that
generates a file according to the specifications in Pub.
1220. The IRS does not provide a fill-in form option for
Copy A.
Need help? If you have questions about reporting on
Form 1099-C, call the information reporting customer
service site toll free at 866-455-7438 or 304-263-8700
(not toll free). Persons with a hearing or speech
disability with access to TTY/TDD equipment can call
304-579-4827 (not toll free).