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                                    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 
downloaded and printed and used to satisfy the requirement to provide the information to 
the recipient.

To order official IRS information returns, which include a scannable Copy A for filing with 
the IRS and all other applicable copies of the form, visit www.IRS.gov/orderforms. Click on 
Employer and Information Returns, and we’ll mail you the forms you request and their 
instructions, as well as any publications you may order.

Information returns may also be filed electronically using the IRS Filing Information Returns 
Electronically (FIRE) system (visit www.IRS.gov/FIRE) or the IRS Affordable Care Act 
Information Returns (AIR) program (visit www.IRS.gov/AIR).

See IRS Publications 1141, 1167, and 1179 for more information about printing these tax 
forms.



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               8585                          VOID   CORRECTED
CREDITOR’S name, street address, city or town, state or province, country, 1 Date of identifiable event     OMB No. 1545-1424
ZIP or foreign postal code, and telephone no.
                                                                           2 Amount of debt discharged      Form 1099-C                     Cancellation 
                                                                           $                                  (Rev. January 2022)           of Debt
                                                                           3 Interest, if included in box 2   For calendar year     
                                                                           $                                     20
CREDITOR’S TIN                      DEBTOR’S TIN                           4 Debt description                                               Copy A
                                                                                                                                            For 
DEBTOR’S name                                                                                                                               Internal Revenue 
                                                                                                                                            Service Center
                                                                                                                                            File with Form 1096. 
Street address (including apt. no.)                                        5 Check here if the debtor was personally liable for             For Privacy Act and 
                                                                            repayment of the debt    .      . .  . . . .          .         Paperwork Reduction 
City or town, state or province, country, and ZIP or foreign postal code                                                                    Act Notice, see the 
                                                                                                                                            current General 
                                                                                                                                            Instructions for 
Account number (see instructions)                                          6 Identifiable event code        7 Fair market value of property Certain Information 
                                                                                                            $                               Returns.
Form  1099-C (Rev. 1-2022)          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



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                                                 CORRECTED (if checked)
CREDITOR’S name, street address, city or town, state or province, country, 1 Date of identifiable event     OMB No. 1545-1424
ZIP or foreign postal code, and telephone no.
                                                                           2 Amount of debt discharged      Form 1099-C                     Cancellation 
                                                                           $                                  (Rev. January 2022)           of Debt
                                                                           3 Interest, if included in box 2   For calendar year     
                                                                           $                                     20
CREDITOR’S TIN                      DEBTOR’S TIN                           4 Debt description                                               Copy B
                                                                                                                                            For Debtor
DEBTOR’S name                                                                                                                               This is important tax 
                                                                                                                                            information and is being 
                                                                                                                                            furnished to the IRS. If 
                                                                                                                                            you are required to file a 
Street address (including apt. no.)                                        5 If checked, the debtor was personally liable for               return, a negligence 
                                                                            repayment of the debt    .      . .  . . .        .   .         penalty or other 
                                                                                                                                            sanction may be 
City or town, state or province, country, and ZIP or foreign postal code                                                                    imposed on you if 
                                                                                                                                            taxable income results 
                                                                                                                                            from this transaction 
                                                                                                                                            and the IRS determines 
Account number (see instructions)                                          6 Identifiable event code        7 Fair market value of property that it has not been 
                                                                                                            $                               reported.
Form  1099-C (Rev. 1-2022)          (keep for your records)                www.irs.gov/Form1099C              Department of the Treasury - Internal Revenue Service



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Instructions for Debtor                                                            see if you must include the interest in gross income.
You received this form because a federal government agency or an applicable        Box 4. Shows a description of the debt. If box 7 is completed, box 4 also shows 
financial entity (a creditor) has discharged (canceled or forgiven) a debt you     a description of the property. 
owed, or because an identifiable event has occurred that either is or is deemed    Box 5. Shows whether you were personally liable for repayment of the debt 
to be a discharge of a debt of $600 or more. If a creditor has discharged a debt   when the debt was created or, if modified, at the time of the last modification. 
you owed, you are required to include the discharged amount in your income,        See Pub. 4681 for reporting instructions.  
even if it is less than $600, on the “Other income” line of your Form 1040 or      Box 6. Shows the reason your creditor has filed this form. The codes in this box 
1040-SR. However, you may not have to include all of the canceled debt in your     are described in more detail in Pub. 4681. A—Bankruptcy; B—Other judicial 
income. There are exceptions and exclusions, such as bankruptcy and                debt relief; C—Statute of limitations or expiration of deficiency period; D—
insolvency. See Pub. 4681, available at www.irs.gov/Pub4681, for more details.     Foreclosure election; E—Debt relief from probate or similar proceeding; F—By 
If an identifiable event has occurred but the debt has not actually been           agreement; G—Decision or policy to discontinue collection; or H—Other actual 
discharged, then include any discharged debt in your income in the year that it    discharge before identifiable event.  
is actually discharged, unless an exception or exclusion applies to you in that    Box 7. If, in the same calendar year, a foreclosure or abandonment of property 
year.                                                                              occurred in connection with the cancellation of the debt, the fair market value 
Debtor’s taxpayer identification number (TIN). For your protection, this form      (FMV) of the property will be shown, or you will receive a separate Form 1099-A. 
may show only the last four digits of your TIN (social security number (SSN),      Generally, the gross foreclosure bid price is considered to be the FMV. For an 
individual taxpayer identification number (ITIN), adoption taxpayer identification abandonment or voluntary conveyance in lieu of foreclosure, the FMV is 
number (ATIN), or employer identification number (EIN)). However, the creditor     generally the appraised value of the property. You may have income or loss 
has reported your complete TIN to the IRS.                                         because of the acquisition or abandonment. See Pub. 4681 for information 
Account number. May show an account or other unique number the creditor            about foreclosures and abandonments. If the property was your main home, see 
assigned to distinguish your account.                                              Pub. 523 to figure any taxable gain or ordinary income.
Box 1. Shows the date the earliest identifiable event occurred or, at the          Future developments. For the latest information about developments related to 
creditor’s discretion, the date of an actual discharge that occurred before an     Form 1099-C and its instructions, such as legislation enacted after they were 
identifiable event. See the code in box 6.                                         published, go to www.irs.gov/Form1099C.
Box 2. Shows the amount of debt either actually or deemed discharged. Note: If     Free File Program. Go to www.irs.gov/FreeFile to see if you qualify for no-cost 
you don’t agree with the amount, contact your creditor.                            online federal tax preparation, e-filing, and direct deposit or payment options.
Box 3. Shows interest if included in the debt reported in box 2. See Pub. 4681 to



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                                             VOID CORRECTED
CREDITOR’S name, street address, city or town, state or province, country, 1 Date of identifiable event     OMB No. 1545-1424
ZIP or foreign postal code, and telephone no.
                                                                           2 Amount of debt discharged      Form 1099-C                     Cancellation 
                                                                           $                                  (Rev. January 2022)           of Debt
                                                                           3 Interest, if included in box 2   For calendar year     
                                                                           $                                     20
CREDITOR’S TIN                      DEBTOR’S TIN                           4 Debt description                                               Copy C
                                                                                                                                            For Creditor
DEBTOR’S name
                                                                                                                                            For Privacy Act 
                                                                                                                                            and Paperwork 
Street address (including apt. no.)                                        5 Check here if the debtor was personally liable for             Reduction Act 
                                                                            repayment of the debt    .      . .  . . . .          .         Notice, see the 
                                                                                                                                            current General 
City or town, state or province, country, and ZIP or foreign postal code                                                                    Instructions for 
                                                                                                                                            Certain Information 
Account number (see instructions)                                          6 Identifiable event code        7 Fair market value of property Returns.
                                                                                                            $
Form  1099-C (Rev. 1-2022)                        www.irs.gov/Form1099C                                       Department of the Treasury - Internal Revenue Service



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Instructions for Creditor
To complete Form 1099-C, use:                         Filing and furnishing. For filing and furnishing 
• The current General Instructions for Certain        instructions, including due dates, and to request filing or 
Information Returns, and                              furnishing extensions, see the current General 
• The current Instructions for Forms 1099-A and       Instructions for Certain Information Returns. 
1099-C.                                               Need help? If you have questions about reporting on 
To order these instructions and additional forms, go  Form 1099-C, call the information reporting customer 
to www.irs.gov/EmployerForms.                         service site toll free at 866-455-7438 or 304-263-8700 
                                                      (not toll free). Persons with a hearing or speech 
Caution: Because paper forms are scanned during 
                                                      disability with access to TTY/TDD equipment can call 
processing, you cannot file certain Forms 1096, 1097, 
                                                      304-579-4827 (not toll free). 
1098, 1099, 3921, or 5498 that you print from the IRS 
website.






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