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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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8080 VOID CORRECTED
LENDER’S name, street address, city or town, state or province, country, ZIP or OMB No. 1545-0877
foreign postal code, and telephone no. Form 1099-A Acquisition or
(Rev. January 2022) Abandonment of
For calendar year Secured Property
20
1 Date of lender’s acquisition or 2 Balance of principal Copy A
LENDER’S TIN BORROWER’S TIN knowledge of abandonment outstanding For
$ Internal Revenue
BORROWER’S name 3 4 Fair market value of property Service Center
File with Form 1096.
$ For Privacy Act
Street address (including apt. no.) 5 Check if the borrower was personally liable for repayment of and Paperwork
the debt . . . . . . . . . . . . ▶ Reduction Act
Notice, see the
City or town, state or province, country, and ZIP or foreign postal code 6 Description of property current General
Instructions for
Certain
Account number (see instructions) Information
Returns.
Form 1099-A (Rev. 1-2022) Cat. No. 14412G www.irs.gov/Form1099A 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)
LENDER’S name, street address, city or town, state or province, country, ZIP or OMB No. 1545-0877
foreign postal code, and telephone no. Form 1099-A Acquisition or
(Rev. January 2022) Abandonment of
For calendar year Secured Property
20
1 Date of lender’s acquisition or 2 Balance of principal Copy B
LENDER’S TIN BORROWER’S TIN knowledge of abandonment outstanding For Borrower
$ This is important tax
BORROWER’S name 3 4 Fair market value of property information and is being
furnished to the IRS. If
you are required to file a
$ return, a negligence
Street address (including apt. no.) 5 If checked, the borrower was personally liable for repayment penalty or other
▶ sanction may be
of the debt . . . . . . . . . . . imposed on you if
City or town, state or province, country, and ZIP or foreign postal code 6 Description of property taxable income results
from this transaction
and the IRS determines
Account number (see instructions) that it has not been
reported.
Form 1099-A (Rev. 1-2022) (keep for your records) www.irs.gov/Form1099A Department of the Treasury - Internal Revenue Service

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Instructions for Borrower or the date possession and the burdens and benefits of ownership were
transferred to the lender. This may be the date of a foreclosure or execution sale
Certain lenders who acquire an interest in property that was security for a loan or the date your right of redemption or objection expired. For an abandonment,
or who have reason to know that such property has been abandoned must the date shown is the date on which the lender first knew or had reason to know
provide you with this statement. You may have reportable income or loss that the property was abandoned or the date of a foreclosure, execution, or
because of such acquisition or abandonment. Gain or loss from an acquisition is similar sale.
generally measured by the difference between your adjusted basis in the
property and the amount of your debt canceled in exchange for the property or, Box 2. Shows the debt (principal only) owed to the lender on the loan when the
if greater, the sale proceeds. If you abandoned the property, you may have interest in the property was acquired by the lender or on the date the lender first
income from the discharge of indebtedness in the amount of the unpaid balance knew or had reason to know that the property was abandoned.
of your canceled debt. The tax consequences of abandoning property depend Box 3. Reserved for future use.
on whether or not you were personally liable for the debt. Losses on acquisitions Box 4. Shows the fair market value of the property. If the amount in box 4 is less
or abandonments of property held for personal use are not deductible. See Pub. than the amount in box 2, and your debt is canceled, you may have cancellation
4681 for information about your tax consequences. of debt income. If the property was your main home, see Pub. 523 to figure any
Property means any real property (such as a personal residence), any taxable gain or ordinary income.
intangible property, and tangible personal property that is held for investment or Box 5. Shows whether you were personally liable for repayment of the debt
used in a trade or business. when the debt was created or, if modified, when it was last modified.
If you borrowed money on this property with someone else, each of you Box 6. Shows the description of the property acquired by the lender or
should receive this statement. abandoned by you. If “CCC” is shown, the form indicates the amount of any
Borrower’s taxpayer identification number (TIN). For your protection, this Commodity Credit Corporation loan outstanding when you forfeited your
form may show only the last four digits of your TIN (social security number commodity.
(SSN), individual taxpayer identification number (ITIN), adoption taxpayer Future developments. For the latest information about developments related to
identification number (ATIN), or employer identification number (EIN)). However, Form 1099-A and its instructions, such as legislation enacted after they were
the issuer has reported your complete TIN to the IRS. published, go to www.irs.gov/Form1099A.
Account number. May show an account or other unique number the lender Free File Program. Go to www.irs.gov/FreeFile to see if you qualify for no-cost
assigned to distinguish your account. online federal tax preparation, e-filing, and direct deposit or payment options.
Box 1. For a lender’s acquisition of property that was security for a loan, the
date shown is generally the earlier of the date title was transferred to the lender

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VOID CORRECTED
LENDER’S name, street address, city or town, state or province, country, ZIP or OMB No. 1545-0877
foreign postal code, and telephone no. Form 1099-A Acquisition or
(Rev. January 2022) Abandonment of
For calendar year Secured Property
20
1 Date of lender’s acquisition or 2 Balance of principal Copy C
LENDER’S TIN BORROWER’S TIN knowledge of abandonment outstanding For Lender
$
BORROWER’S name 3 4 Fair market value of property
For Privacy Act
and Paperwork
$ Reduction Act
Street address (including apt. no.) 5 Check if the borrower was personally liable for repayment of Notice, see the
the debt . . . . . . . . . . . . ▶ current General
Instructions for
City or town, state or province, country, and ZIP or foreign postal code 6 Description of property Certain
Information
Returns.
Account number (see instructions)

Form 1099-A (Rev. 1-2022) www.irs.gov/Form1099A Department of the Treasury - Internal Revenue Service

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

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