1099-c_form | Document Preview

CORRECTED (if checked)

CREDITOR’S name, street address, city or town, state or province, country, ZIP orforeign 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

Form 1099-C

(Rev. January 2022)

For calendar year

2024

Cancellation
of Debt

CREDITOR’S TIN	DEBTOR’S TIN
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)

4 Debt description

5 If checked, the debtor was personally liable for repayment of the debt . . checkbox

6 Identifiable event code

7	Fair market value of property
$

Copy B
For Debtor

This is important tax information and is being furnished to the IRS. 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.

Form 1099-C (Rev. 1-2022)

(keep for your records)

www.irs.gov/Form1099C

Department of the Treasury - Internal Revenue Service

Cancellation of Debt

Copy B For Debtor

Cancellation
of Debt

Copy B
For Debtor