Form 1099-A - Acquisition Or Abandonment Of Secured Property

Form 1099-A - Acquisition Or Abandonment Of Secured Property - 2017 Page 3

CORRECTED (if checked)

city or town, state or province, country, ZIP or

OMB No. 1545-0877

LENDER’S name, street address,

foreign postal code, a

nd telephone no.

Acquisition or

2017

Abandonment of

Secured Property

1099-A

Form

Copy B

1 Date of lender's acquisition or

2 Balance of principal

knowledge of abandonment

outstanding

For Borrower

LENDER’S federal identification number

BORROWER’S identification number

This is important tax

information and is being

BORROWER’S name

4 Fair market value of property

furnished to the Internal

Revenue Service. 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

6 Description of property

City or town, state or province, country, and ZIP or foreign postal code

taxable income results

from this transaction

and the IRS determines

Account number (see instructions)

that it has not been

reported.

1099-A

(keep for your records)

Form

Department of the Treasury - Internal Revenue Service

Form 1099-A - Acquisition Or Abandonment Of Secured Property - 2017 Page 3

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