Form W-2G Certain Gambling Winnings

3232

CORRECTED

PAYER’S name

1 Gross winnings

2 Federal income tax withheld

Street address

3 Type of wager

4 Date won

City, state, and ZIP code

5 Transaction

6 Race

7 Winnings from identical wagers

8 Cashier

9 Winner’s taxpayer identification no.

10 Window

OMB No. 1545-0238

2008
Form W-2G

Federal identification number

WINNER’S name

Telephone number

Street address (including apt. no.)

11 First I.D.

12 Second I.D.

City, state, and ZIP code

13 State/Payer’s state identification no.

14 State income tax withheld

Certain
Gambling
Winnings
For Privacy Act and
Paperwork Reduction Act
Notice, see the 2008
General Instructions for
Forms 1099, 1098, 5498,
and W-2G.
File with Form 1096.

Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identification number that I have furnished
correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments.

Signature
Form

W-2G

©

Date
Cat. No. 10138V

©

Copy A
For Internal Revenue
Service Center

Department of the Treasury - Internal Revenue Service

Note: Form W-2G is printed black & white, not color like the other W-2s.

CORRECTED
PAYER’S name, address, ZIP code, federal identification
number, and telephone number

1 Gross winnings

2 Federal income tax withheld

3 Type of wager

4 Date won

5 Transaction

6 Race

7 Winnings from identical wagers

8 Cashier

9 Winner’s taxpayer identification no.

10 Window

OMB No. 1545-0238

2008
Form W-2G

WINNER’S name, address (including apt. no.), and ZIP code

11 First I.D.

12 Second I.D.

13 State/Payer’s state identification no.

14 State income tax withheld

Certain
Gambling
Winnings

Copy 1
For State Tax
Department

Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identification number that I have furnished
correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments.

Signature
Form

W-2G

©

Date

©

Department of the Treasury - Internal Revenue Service

CORRECTED (if checked)
PAYER’S name, address, ZIP code, federal identification
number, and telephone number

1 Gross winnings

2 Federal income tax withheld

3 Type of wager

4 Date won

5 Transaction

6 Race

7 Winnings from identical wagers

8 Cashier

9 Winner’s taxpayer identification no.

10 Window

OMB No. 1545-0238

2008
Form W-2G

WINNER’S name, address (including apt. no.), and ZIP code

Certain
Gambling
Winnings
This information is
being furnished to
the Internal
Revenue Service.

11 First I.D.

12 Second I.D.

13 State/Payer’s state identification no.

14 State income tax withheld

Copy B

Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identification number that I have furnished
correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments.

Report this income on your
federal tax return. If this
form shows federal income
tax withheld in box 2, attach
this copy to your return.

Signature
Form

W-2G

©

Date

©

Department of the Treasury - Internal Revenue Service

CORRECTED (if checked)
PAYER’S name, address, ZIP code, federal identification
number, and telephone number

1 Gross winnings

2 Federal income tax withheld

3 Type of wager

4 Date won

5 Transaction

6 Race

7 Winnings from identical wagers

8 Cashier

9 Winner’s taxpayer identification no.

10 Window

OMB No. 1545-0238

2008
Form W-2G

WINNER’S name, address (including apt. no.), and ZIP code

11 First I.D.

12 Second I.D.

13 State/Payer’s state identification no.

14 State income tax withheld

Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identification number that I have furnished
correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments.

Signature
Form

W-2G

©

Date

©

Certain
Gambling
Winnings
This is important tax
information and is being
furnished to the Internal
Revenue Service. If you are
required to file a return, a
negligence penalty or other
sanction may be imposed on
you if this income is taxable
and the IRS determines that
it has not been reported.

Copy C
For Winner’s
Records

Department of the Treasury - Internal Revenue Service

Instructions to Winner
Box 1. The payer must furnish a Form W-2G to you if you
receive:
1. $600 or more in gambling winnings and the payout is at
least 300 times the amount of the wager (except winnings
from bingo, keno, and slot machines);
2. $1,200 or more in gambling winnings from bingo or slot
machines;
3. $1,500 or more in proceeds (the amount of winnings
less the amount of the wager) from keno; or
4. Any gambling winnings subject to federal income tax
withholding.
Generally, report all gambling winnings on the “Other
income” line of Form 1040. You can deduct gambling losses
as an itemized deduction, but you cannot deduct more than
your winnings. Keep an accurate record of your winnings and
losses, and be able to prove those amounts with receipts,
tickets, statements, or similar items that you have saved. For
additional information, see Pub. 17, Your Federal Income
Tax, Pub. 505, Tax Withholding and Estimated Tax, and Pub.
525, Taxable and Nontaxable Income.

Box 2. Any federal income tax withheld on these winnings is
shown in this box. Federal income tax must be withheld at
the rate of 25% on certain winnings less the wager.
If you did not provide your federal identification number to
the payer, the amount in this box may be subject to backup
withholding at a 28% rate.
Include the amount shown in box 2 on your Form 1040 as
federal income tax withheld.
Signature. You must sign Form W-2G if you are the only
person entitled to the winnings and the winnings are subject
to regular gambling withholding.
Other winners. Prepare Form 5754, Statement by Person(s)
Receiving Gambling Winnings, if another person is entitled to
any part of these winnings. Give Form 5754 to the payer.

CORRECTED (if checked)
PAYER’S name, address, ZIP code, federal identification
number, and telephone number

1 Gross winnings

2 Federal income tax withheld

3 Type of wager

4 Date won

5 Transaction

6 Race

7 Winnings from identical wagers

8 Cashier

9 Winner’s taxpayer identification no.

10 Window

OMB No. 1545-0238

2008
Form W-2G

WINNER’S name, address (including apt. no.), and ZIP code

11 First I.D.

12 Second I.D.

13 State/Payer’s state identification no.

14 State income tax withheld

Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identification number that I have furnished
correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments.

Signature
Form

W-2G

©

Date

Certain
Gambling
Winnings

Copy 2
Attach this copy
to your state
income tax return,
if required.

©

Department of the Treasury - Internal Revenue Service

CORRECTED
PAYER’S name, address, ZIP code, federal identification
number, and telephone number

1 Gross winnings

2 Federal income tax withheld

3 Type of wager

4 Date won

5 Transaction

6 Race

7 Winnings from identical wagers

8 Cashier

9 Winner’s taxpayer identification no.

10 Window

OMB No. 1545-0238

2008
Form W-2G

WINNER’S name, address (including apt. no.), and ZIP code

11 First I.D.

12 Second I.D.

13 State/Payer’s state identification no.

14 State income tax withheld

Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identification number that I have furnished
correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments.

Certain
Gambling
Winnings
For Privacy Act and
Paperwork Reduction Act
Notice, see the 2008
General Instructions for
Forms 1099, 1098, 5498,
and W-2G.

Copy D
For Payer

Signature
Form

W-2G

©

Date

©

Department of the Treasury - Internal Revenue Service

Instructions for Payers
General and specific form instructions are provided as
separate products. The products you should use to
complete Form W-2G are the 2008 General Instructions
for Forms 1099, 1098, 5498, and W-2G and the 2008
Instructions for Forms W-2G and 5754. To order
these instructions and additional forms, visit the
IRS website at www.irs.gov, or call 1-800-TAX-FORM
(1-800-829-3676).

Foreign winners. Use Form 1042-S, Foreign Person’s
U.S. Source Income Subject to Withholding, to report
gambling winnings paid to nonresident aliens and
foreign corporations. See the Instructions for Form
1042-S. You may be required to withhold federal
income tax at a 30% rate. See Pub. 515, Withholding
of Tax on Nonresident Aliens and Foreign Entities.

Due dates. Furnish Copies B and C of this form to the
winner by February 2, 2009.

Form 5754. If the person receiving the winnings is not
the actual winner or is a member of a group of
winners, see the instructions for Form 5754, Statement
by Person(s) Receiving Gambling Winnings, in the 2008
Instructions for Forms W-2G and 5754.

File Copy A of this form with the IRS by
March 2, 2009. If you file electronically, the due date is
March 31, 2009.
Gambling withholding. You may be required to
withhold federal income tax from cash or noncash
gambling winnings. See the 2008 Instructions for
Forms W-2G and 5754 for the rates.

Need help? If you have questions about reporting on
Form W-2G, 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 304-267-3367 (not toll free). The hours of operation
are Monday through Friday from 8:30 a.m. to 4:30
p.m., Eastern time.

Printed on recycled paper