Form 1099-A - Acquisition Or Abandonment Of Secured Property

Form 1099-A - Acquisition Or Abandonment Of Secured Property - 2012 Page 3

CORRECTED (if checked)

OMB No. 1545-0877

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

Acquisition or

2012

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

5 If checked, the borrower was personally liable for

Street address (including apt. no.)

penalty or other

repayment of the debt

▶

sanction may be

imposed on you if

6 Description of property

City, state, and ZIP 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 - 2012 Page 3

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