Template 1099 Preprinted Forms

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This form is provided for informational purposes only. Copy A appears in red,
similar to the official IRS form. Do not file copy A with the IRS. The official printed
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about printing these tax forms.
                    8080                       VOID             CORRECTED
LENDER’S name, street address, city, state, ZIP code, and telephone no.                                          OMB No. 1545-0877

   STRAWMAN                                                                                                                                      Acquisition or
   ADDRESS                                                                                                          2008                       Abandonment of
                                                                                                                                              Secured Property
   CITY STATE                                               ZIP                                                    Form   1099-A
   (XXX) 123 4567                                                            1 Date of lender’s acquisition or   2 Balance of principal
                                                                               knowledge of abandonment            outstanding                               Copy A
LENDER’S federal identification number   BORROWER’S identification number
                                                                                                                                                                 For
       123-45-6789                        ask or W9 or "refused"                 Date of case or orig note       $ 36,545.00                        Internal Revenue
BORROWER’S name                                                              3                                   4 Fair market value of property      Service Center
                                                                                                                                                   File with Form 1096.
       ACME WIDGETS, LLC
                                                                                                                 $ 36,545.00                          For Privacy Act
Street address (including apt. no.)                                          5 Was borrower personally liable for repayment of the debt?              and Paperwork
    ADDRESS                                                                                                                  STREET ADDRESS
                                                                                                                                 Yes          No       Reduction Act
City, state, and ZIP code                                                    6 Description of property
                                                                                                                                                      Notice, see the
                                                                                                                                                       2008 General
    CITY                                 STATE       [ ZIP ]                     STRAWMAN'S NAME                                                     Instructions for
Account number (see instructions)                                                                                                                  Forms 1099, 1098,
    Case (or mortg acct) No. _____________                                       Case (or mortg acct) No. _________                                 5498, and W-2G.
Form   1099-A                                                             Cat. No. 14412G                         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
       .STRAWMAN FULL NAME
Do Not Staple           6969
                                                                                                                                                          OMB No. 1545-0108

 Form    1096                                           Annual Summary and Transmittal of
 Department of the Treasury
 Internal Revenue Service
                                                            U.S. Information Returns                                                                        2006
        FILER’S name
        .STRAWMAN FULL NAME

        Street address (including room or suite number)

        STREET ADDRESS
        City, state, and ZIP code
        CITY STATE AND ZIP
 Name of person to contact                                           Telephone number                                           For Official Use Only
 YOUR NAME                                                           (     ) ----------------------
 Email address                                                       Fax number
 ------------------------                                            (     ) -----------------------
 1 Employer identification number       2 Social security number     3 Total number of        4 Federal income tax withheld       5 Total amount reported with this Form 1096
                                                                       forms TOTAL # OF PAGES
 W/O DASHES XXXXXXXXX                    W/DASHES XXX-XXX-XXXX                                         $ --------                   $ -------
 Enter an “X” in only one box below to indicate the type of form being filed.                        If this is your final return, enter an “X” here
   W-2G          1098          1098-C        1098-E     1098-T     1099-A      1099-B       1099-C       1099-CAP   1099-DIV    1099-G      1099-H      1099-INT      1099-LTC
    32            81             78            84         83         80          79           85            73         91         86          71           92            93

                                                                   X
1099-MISC       1099-OID      1099-PATR      1099-Q     1099-R     1099-S     1099-SA        5498        5498-ESA   5498-SA
    95             96             97           31         98         75          94           28            72         27




Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.
  Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true,
correct, and complete.



Signature       By: YOUR NAME                                                  Title    AUTHORIZED REPRESENTATIVE                              Date     DATE
Instructions                                                                                 When to file. File Form 1096 as follows.
                                                                                             ● With Forms 1099, 1098, or W-2G, file by February 28, 2007.
Purpose of form. Use this form to transmit paper Forms 1099,
1098, 5498, and W-2G to the Internal Revenue Service. Do not                                 ● With Forms 5498, 5498-ESA, or 5498-SA, file by May 31, 2007.
use Form 1096 to transmit electronically or magnetically. For                                Where To File
magnetic media, see Form 4804, Transmittal of Information
Returns Reported Magnetically; for electronic submissions, see                               Except for Form 1098-C, send all information returns filed on
Pub. 1220, Specifications for Filing Forms 1098, 1099, 5498, and                             paper with Form 1096 to the following:
W-2G Electronically or Magnetically.                                                          If your principal business,                  Use the following
Who must file. The name, address, and TIN of the filer on this                                 office or agency, or legal                  Internal Revenue
form must be the same as those you enter in the upper left area                              residence in the case of an                     Service Center
of Forms 1099, 1098, 5498, or W-2G. A filer includes a payer; a                                 individual, is located in                       address
recipient of mortgage interest payments (including points) or
student loan interest; an educational institution; a broker; a
barter exchange; a creditor; a person reporting real estate                                  Alabama, Arizona, Arkansas, Connecticut,
transactions; a trustee or issuer of any individual retirement                               Delaware, Florida, Georgia, Kentucky,
arrangement, a Coverdell ESA, an HSA, an Archer MSA                                          Louisiana, Maine, Massachusetts,
(including a Medicare Advantage MSA); certain corporations;                                  Mississippi, New Hampshire, New Jersey,                     Austin, TX 73301
certain donees of motor vehicles, boats, and airplanes; and a                                New Mexico, New York, North Carolina,
lender who acquires an interest in secured property or who has                               Ohio, Pennsylvania, Rhode Island, Texas,
reason to know that the property has been abandoned.                                         Vermont, Virginia, West Virginia
Preaddressed Form 1096. If you received a preaddressed Form
1096 from the IRS with Package 1099, use it to transmit paper                                Alaska, California, Colorado, District of
Forms 1099, 1098, 5498, and W-2G to the Internal Revenue                                     Columbia, Hawaii, Idaho, Illinois, Indiana, Iowa,
Service. If any of the preprinted information is incorrect, make                             Kansas, Maryland, Michigan, Minnesota,
corrections on the form.                                                                     Missouri, Montana, Nebraska, Nevada, North                  Kansas City, MO
   If you are not using a preaddressed form, enter the filer’s                               Dakota, Oklahoma, Oregon, South Carolina,                             64999
name, address (including room, suite, or other unit number), and                             South Dakota, Tennessee, Utah, Washington,
TIN in the spaces provided on the form.                                                      Wisconsin, Wyoming

For more information and the Privacy Act and Paperwork Reduction Act Notice,                                   Cat. No. 14400O                   Form   1096       (Rev. 7-2006)
see the 2006 General Instructions for Forms 1099, 1098, 5498, and W-2G.
                                                                CORRECTED (if checked)
LENDER’S name, street address, city, state, ZIP code, and telephone no.                                         OMB No. 1545-0877
                                                                                                                                            Acquisition or
                                                                                                                    2008                  Abandonment of
                                                                                                                                         Secured Property
                                                                                                                  Form   1099-A
                                                                            1 Date of lender’s acquisition or   2 Balance of principal
                                                                              knowledge of abandonment            outstanding                              Copy B
LENDER’S federal identification number   BORROWER’S identification number
                                                                                                                                                    For Borrower
                                                                                                                $                               This is important tax
BORROWER’S name                                                             3                              4 Fair market value of property information and is being
                                                                                                                                            furnished to the Internal
                                                                                                                                            Revenue Service. If you
                                                                                                           $                                     are required to file a
                                                                            5 Was borrower personally liable for repayment of the debt?          return, a negligence
Street address (including apt. no.)
                                                                                                                                                      penalty or other
                                                                                                                           Yes       No              sanction may be
City, state, and ZIP code                                                                                                                          imposed on you if
                                                                            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                                                    (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    ownership were transferred to the lender. This may be the date of a
loan or who have reason to know that such property has been                    foreclosure or execution sale or the date your right of redemption or
abandoned must provide you with this statement. You may have                   objection expired. For an abandonment, the date shown is the date on
reportable income or loss because of such acquisition or abandonment.          which the lender first knew or had reason to know that the property was
Gain or loss from an acquisition generally is measured by the difference       abandoned or the date of a foreclosure, execution, or similar sale.
between your adjusted basis in the property and the amount of your debt        Box 2. Shows the debt (principal only) owed to the lender on the loan
canceled in exchange for the property, or, if greater, the sale proceeds. If   when the interest in the property was acquired by the lender or on the
you abandoned the property, you may have income from the discharge of          date the lender first knew or had reason to know that the property was
indebtedness in the amount of the unpaid balance of your canceled debt.        abandoned.
You also may have a loss from abandonment up to the adjusted basis of
                                                                               Box 4. Shows the fair market value of the property. If the amount in box
the property at the time of abandonment. Losses on acquisitions or
                                                                               4 is less than the amount in box 2, and your debt is canceled, you may
abandonments of property held for personal use are not deductible. See
                                                                               have cancellation of debt income. If the property was your main home,
Pub. 544, Sales and Other Dispositions of Assets, for information about
                                                                               see Pub. 523, Selling Your Home, to figure any taxable gain or ordinary
foreclosures and abandonments.
                                                                               income.
    Property means any real property (such as a personal residence); any
intangible property; and tangible personal property that is held for           Box 5. Shows whether you were personally liable for repayment of the
investment or used in a trade or business.                                     loan 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 should receive this statement.                                             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
 Account number. May show an account or other unique number the                any Commodity Credit Corporation loan outstanding when you forfeited
lender assigned to distinguish your account.                                   your commodity.
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
                                               VOID             CORRECTED
LENDER’S name, street address, city, state, ZIP code, and telephone no.                                         OMB No. 1545-0877
                                                                                                                                            Acquisition or
                                                                                                                    2008                  Abandonment of
                                                                                                                                         Secured Property
                                                                                                                  Form   1099-A
                                                                            1 Date of lender’s acquisition or   2 Balance of principal
LENDER’S federal identification number   BORROWER’S identification number
                                                                              knowledge of abandonment            outstanding                              Copy C
                                                                                                                $                                      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 Was borrower personally liable for repayment of the debt?            Notice, see the
                                                                                                                                Yes      No         2008 General
City, state, and ZIP code                                                   6 Description of property                                             Instructions for
                                                                                                                                                     Forms 1099,
                                                                                                                                                       1098, 5498,
Account number (see instructions)
                                                                                                                                                       and W-2G.

Form   1099-A                                                                                                    Department of the Treasury - Internal Revenue Service
Instructions for Lenders
General and specific form instructions are provided as       File Copy A of this form with the IRS by March 2,
separate products. The products you should use to        2009. If you file electronically, the due date is March
complete Form 1099-A are the 2008 General                31, 2009. To file electronically, you must have software
Instructions for Forms 1099, 1098, 5498, and W-2G,       that generates a file according to the specifications in
and the 2008 Instructions for Forms 1099-A and           Pub. 1220, Specifications for Filing Forms 1098, 1099,
1099-C. A chart in the general instructions gives a      5498, and W-2G Electronically. IRS does not provide a
quick guide to which form must be filed to report a      fill-in form option.
particular payment. To order these instructions and      Need help? If you have questions about reporting on
additional forms, visit the IRS website at www.irs.gov   Form 1099-A, call the information reporting customer
or call 1-800-TAX-FORM (1-800-829-3676).                 service site toll free at 1-866-455-7438 or
Caution: Because paper forms are scanned during          304-263-8700 (not toll free). For TTY/TDD equipment,
processing, you cannot file Forms 1096, 1098, 1099, or   call 304-267-3367 (not toll free). The hours of operation
5498 that you download and print from the IRS            are Monday through Friday from 8:30 a.m. to 4:30 p.m.
website.                                                 Eastern time.
Due dates. Furnish Copy B of this form to the
borrower by February 2, 2009.

				
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