Form 1099-A Acquisition or Abandonment of Secured Property

Attention:
This form is provided for informational purposes only. Copy A appears in red, similar to the
official IRS form. Do not file copy A downloaded from this website. The official printed
version of this IRS form is scannable, but the online version of it, printed from this website, is
not. A penalty may be imposed for filing forms that can’t be scanned. See part O in the
current General Instructions for Certain Information Returns for more information about
penalties.
To order official IRS forms, call 1-800-TAX-FORM (1-800-829-3676) or Order
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forms and other products.
See IRS Publications 1141, 1167, 1179 and other IRS resources for information about
printing these tax forms.

8080

VOID

CORRECTED

LENDER’S name, street address, city, state, ZIP code, and telephone no.

OMB No. 1545-0877

2011
Form

LENDER’S federal identification number

BORROWER’S identification number

1 Date of lender’s acquisition or
knowledge of abandonment

1099-A

Acquisition or
Abandonment of
Secured Property

2 Balance of principal
outstanding

$
3

BORROWER’S name

4 Fair market value of property

Copy A
For
Internal Revenue
Service Center
File with Form 1096.

$
Street address (including apt. no.)

5 Check here if the borrower was personally liable for
䊳
repayment of the debt

City, state, and ZIP code

6 Description of property

Account number (see instructions)

Form

1099-A

Cat. No. 14412G

Do Not Cut or Separate Forms on This Page

—

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2011 General
Instructions for
Certain
Information
Returns.

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

CORRECTED (if checked)
LENDER’S name, street address, city, state, ZIP code, and telephone no.

OMB No. 1545-0877

2011
Form

LENDER’S federal identification number

BORROWER’S identification number

1 Date of lender’s acquisition or
knowledge of abandonment

$

BORROWER’S name

Street address (including apt. no.)
City, state, and ZIP code

Account number (see instructions)

Form

1099-A

1099-A

2 Balance of principal
outstanding

Acquisition or
Abandonment of
Secured Property
Copy B
For Borrower

This is important tax
4 Fair market value of property information and is being
furnished to the Internal
Revenue Service. If you
are required to file a
$
return, a negligence
5 If checked, the borrower was personally liable for
penalty or other
䊳
repayment of the debt
sanction may be
imposed on you if
6 Description of property
taxable income results
from this transaction
and the IRS determines
that it has not been
reported.
3

(keep for your records)

Department of the Treasury - Internal Revenue Service

Instructions for Borrower
Certain lenders who acquire an interest in property that was security for a
loan or who have reason to know that such property has been
abandoned must provide you with this statement. You may have
reportable income or loss because of such acquisition or abandonment.
Gain or loss from an acquisition generally is measured by the difference
between your adjusted basis in the property and the amount of your debt
canceled in exchange for the property, or, if greater, the sale proceeds. If
you abandoned the property, you may have income from the discharge of
indebtedness in the amount of the unpaid balance of your canceled debt.
You also may have a loss from abandonment up to the adjusted basis of
the property at the time of abandonment. Losses on acquisitions or
abandonments of property held for personal use are not deductible. See
Pub. 4681 for information about foreclosures and abandonments.
Property means any real property (such as a personal residence); any
intangible property; and tangible personal property that is held for
investment or used in a trade or business.
If you borrowed money on this property with someone else, each of
you should receive this statement.
Account number. May show an account or other unique number the
lender assigned to distinguish your account.

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 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 or the date your right of redemption or
objection expired. For an abandonment, the date shown is the date on
which the lender first knew or had reason to know that the property was
abandoned or the date of a foreclosure, execution, or similar sale.
Box 2. Shows the debt (principal only) owed to the lender on the loan
when the interest in the property was acquired by the lender or on the
date the lender first knew or had reason to know that the property was
abandoned.
Box 4. Shows the fair market value of the property. If the amount in box
4 is less than the amount in box 2, and your debt is canceled, you may
have cancellation of debt income. If the property was your main home,
see Pub. 523 to figure any taxable gain or ordinary income.
Box 5. Shows whether you were personally liable for repayment of the
debt when the debt was created or, if modified, when it was last
modified.
Box 6. Shows the description of the property acquired by the lender or
abandoned by you. If “CCC” is shown, the form indicates the amount of
any Commodity Credit Corporation loan outstanding when you forfeited
your commodity.

VOID

CORRECTED

LENDER’S name, street address, city, state, ZIP code, and telephone no.

OMB No. 1545-0877

2011
Form

LENDER’S federal identification number

BORROWER’S identification number

1 Date of lender’s acquisition or
knowledge of abandonment

1099-A

Acquisition or
Abandonment of
Secured Property

2 Balance of principal
outstanding

$
BORROWER’S name

3

4 Fair market value of property

Street address (including apt. no.)

5 Check here if the borrower was personally liable for
䊳
repayment of the debt

City, state, and ZIP code

6 Description of property

$

Account number (see instructions)

Form

1099-A

Copy C
For Lender
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2011 General
Instructions for
Certain
Information
Returns.

Department of the Treasury - Internal Revenue Service

Instructions for Lender
General and specific form instructions are provided as
separate products. The products you should use to
complete Form 1099-A are the 2011 General
Instructions for Certain Information Returns and the
2011 Instructions for Forms 1099-A and 1099-C. A
chart in the general instructions gives a quick guide to
which form must be filed to report a particular
payment. To order these instructions and additional
forms, visit IRS.gov or call 1-800-TAX-FORM
(1-800-829-3676).
Caution: Because paper forms are scanned during
processing, you cannot file Forms 1096, 1097, 1098,
1099, 3921, 3922, or 5498 that you print from the IRS
website.
Due dates. Furnish Copy B of this form to the
borrower by January 31, 2012.

File Copy A of this form with the IRS by February 28,
2012. If you file electronically, the due date is April 2,
2012. To file electronically, you must have software
that generates a file according to the specifications in
Pub. 1220, Specifications for Filing Forms 1097, 1098,
1099, 3921, 3922, 5498, 8935, and W-2G
Electronically. IRS does not provide a fill-in form
option.
Need help? If you have questions about reporting on
Form 1099-A, call the information reporting customer
service site toll free at 1-866-455-7438 or
304-263-8700 (not toll free). For TTY/TDD equipment,
call 304-579-4827 (not toll free). The hours of
operation are Monday through Friday from 8:30 a.m. to
4:30 p.m., Eastern time.