Form 4070A Employee's Daily Record of Tips

Form 4070A
(Rev. August 2005)

Employee’s Daily Record of Tips

Department of the Treasury
Internal Revenue Service

Employee’s name and address

This is a voluntary form provided for your convenience.
See instructions for records you must keep.

Employer’s name

OMB No. 1545-0074
Month and year

Establishment name (if different)
Date
tips
rec’d

Date
of
entry

a. Tips received
directly from customers
and other employees

b. Credit and debit
card tips received

c. Tips paid out to
other employees

d. Names of employees to whom you
paid tips

1
2
3
4
5
Subtotals
For Paperwork Reduction Act Notice, see Instructions on the back of Form 4070.

Page 1

Date
tips
rec’d

Date
of
entry

6
7
8
9
10
11
12
13
14
15
Subtotals

Page 2

a. Tips received
directly from customers
and other employees

b. Credit and debit
card tips received

c. Tips paid out to
other employees

d. Names of employees to whom you
paid tips

Date
tips
rec’d

Date
of
entry

a. Tips received
directly from customers
and other employees

b. Credit and debit
card tips received

c. Tips paid out to
other employees

d. Names of employees to whom you
paid tips

16
17
18
19
20
21
22
23
24
25
Subtotals

Page 3

Date
tips
rec’d

Date
of
entry

a. Tips received
directly from customers
and other employees

b. Credit and debit
card tips received

c. Tips paid out to
other employees

26
27
28
29
30
31
Subtotals
from pages
1, 2, and 3

Totals
1. Report total cash tips (col. a) on Form 4070, line 1.
2. Report total credit and debit card tips (col. b) on Form 4070, line 2.
3. Report total tips paid out (col. c) on Form 4070, line 3.
Page 4

d. Names of employees to whom you
paid tips