Fillable Form W-2G Certain Gambling Winnings 2019

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Form W-2G Certain Gambling Winnings 2019

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Country of origin: US
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Form W-2G
Cat. No. 10138V
Certain
Gambling
Winnings
Copy A
For Internal Revenue
Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096
OMB No. 1545-0238
For Privacy Act and
Paperwork Reduction
Act
Notice, see the 2019
General
Instructions for
Certain Information
Returns.
3232
VOID CORRECTED
2019
PAYER’S name, street address, city or town, province or state, country, and
ZIP or foreign postal code
PAYER’S federal identification number
PAYER’S telephone number
WINNER’S name
Street address (including apt. no.)
City or town, province or state, country, and ZIP or foreign postal code
1 Reportable winnings
$
2 Date won
3 Type of wager 4
Federal income tax withheld
$
5 Transaction 6 Race
7
Winnings from identical wagers
$
8 Cashier
9
Winner’s taxpayer identification no.
10 Window
11 First I.D. 12 Second I.D.
13
State/Payer’s state identification no.
14 State winnings
$
15 State income tax withheld
$
16 Local winnings
$
17 Local income tax withheld
$
18 Name of locality
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
▶
Date
▶
Form W-2G
www.irs.gov/FormW2G
Do Not Cut or Separate Forms on This Page – Do Not Cut or Separate Forms on This Page
Form W-2G
2019
Certain
Gambling
Winnings
Copy 1
For State, City,
or Local Tax
Department
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0238
VOID CORRECTED
PAYER’S name, street address, city or town, province or state, country, and
ZIP or foreign postal code
PAYER’S federal identification number
PAYER’S telephone number
WINNER’S name
Street address (including apt. no.)
City or town, province or state, country, and ZIP or foreign postal code
1 Reportable winnings
$
2 Date won
3 Type of wager 4
Federal income tax withheld
$
5 Transaction 6 Race
7
Winnings from identical wagers
$
8 Cashier
9
Winner’s taxpayer identification no.
10 Window
11 First I.D. 12 Second I.D.
13
State/Payer’s state identification no.
14 State winnings
$
15 State income tax withheld
$
16 Local winnings
$
17 Local income tax withheld
$
18 Name of locality
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
▶
Date
▶
Form W-2G
www.irs.gov/FormW2G
Form W-2G
2019
Certain
Gambling
Winnings
This information
is being furnished
to the Internal
Revenue Service
Copy B
Report this income
on your federal tax
return. If this form
shows federal
income
tax withheld in
box 4, attach this
copy to your return.
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0238
CORRECTED (if checked)
PAYER’S name, street address, city or town, province or state, country, and
ZIP or foreign postal code
PAYER’S federal identification number
PAYER’S telephone number
WINNER’S name
Street address (including apt. no.)
City or town, province or state, country, and ZIP or foreign postal code
1 Reportable winnings
$
2 Date won
3 Type of wager 4
Federal income tax withheld
$
5 Transaction 6 Race
7
Winnings from identical wagers
$
8 Cashier
9
Winner’s taxpayer identification no.
10 Window
11 First I.D. 12 Second I.D.
13
State/Payer’s state identification no.
14 State winnings
$
15 State income tax withheld
$
16 Local winnings
$
17 Local income tax withheld
$
18 Name of locality
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
▶
Date
▶
Form W-2G
www.irs.gov/FormW2G
Form W-2G
2019
Certain
Gambling
Winnings
Copy C
For Winner
’
s Records
Department of the Treasury - Internal Revenue Service
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.
OMB No. 1545-0238
CORRECTED (if checked)
PAYER’S name, street address, city or town, province or state, country, and
ZIP or foreign postal code
PAYER’S federal identification number
PAYER’S telephone number
WINNER’S name
Street address (including apt. no.)
City or town, province or state, country, and ZIP or foreign postal code
1 Reportable winnings
$
2 Date won
3 Type of wager 4
Federal income tax withheld
$
5 Transaction 6 Race
7
Winnings from identical wagers
$
8 Cashier
9
Winner’s taxpayer identification no.
10 Window
11 First I.D. 12 Second I.D.
13
State/Payer’s state identification no.
14 State winnings
$
15 State income tax withheld
$
16 Local winnings
$
17 Local income tax withheld
$
18 Name of locality
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
▶
Date
▶
Form W-2G
www.irs.gov/FormW2G
Instructions to Winner
Box 1. The payer must furnish a Form W-2G to you if you
receive:
1. $1,200 or more in gambling winnings from bingo or slot
machines;
2. $1,500 or more in winnings (reduced by the wager) from
keno;
3. More than $5,000 in winnings (reduced by the wager or
buy-in) from a poker tournament;
4. $600 or more in gambling winnings (except winnings from
bingo, keno, slot machines, and poker tournaments) and the
payout is at least 300 times the amount of the wager; or
5. Any other 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. 529, Miscellaneous
Deductions, and Pub. 525, Taxable and Nontaxable Income.
Box 4. Any federal income tax withheld on these winnings is
shown in this box. Federal income tax must be withheld on
certain winnings less the wager.
Certain winnings that are not subject to regular gambling
withholding may be subject to backup withholding if you did
not provide your federal identification number to the payer.
Include the amount shown in box 4 on your Form 1040 as
federal income tax withheld. See Pub. 505, Tax Withholding
and Estimated Tax, for additional information.
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. Return the signed form to the
payer, who will give you your copies.
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, who
will use Form 5754 to prepare Form W-2G for each person
listed as a winner.
Future developments. For the latest information about
developments related to Form W-2G and its instructions, such
as legislation enacted after they were published, go to
www.irs.gov/FormW2G.
Form W-2G
2019
Certain
Gambling
Winnings
Copy 2
Attach this copy
to your state,
city, or local
income tax return,
if required.
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0238
CORRECTED (if checked)
PAYER’S name, street address, city or town, province or state, country, and
ZIP or foreign postal code
PAYER’S federal identification number
PAYER’S telephone number
WINNER’S name
Street address (including apt. no.)
City or town, province or state, country, and ZIP or foreign postal code
1 Reportable winnings
$
2 Date won
3 Type of wager 4
Federal income tax withheld
$
5 Transaction 6 Race
7
Winnings from identical wagers
$
8 Cashier
9
Winner’s taxpayer identification no.
10 Window
11 First I.D. 12 Second I.D.
13
State/Payer’s state identification no.
14 State winnings
$
15 State income tax withheld
$
16 Local winnings
$
17 Local income tax withheld
$
18 Name of locality
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
▶
Date
▶
Form W-2G
www.irs.gov/FormW2G
Form W-2G
2019
Certain
Gambling
Winnings
Copy D
For Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0238
For Privacy Act and
Paperwork Reduction
Act
Notice, see the 2019
General Instructions
for Certain
Information Returns.
VOID CORRECTED
PAYER’S name, street address, city or town, province or state, country, and
ZIP or foreign postal code
PAYER’S federal identification number
PAYER
’
S telephone number
WINNER’S name
Street address (including apt. no.)
City or town, province or state, country, and ZIP or foreign postal code
1 Reportable winnings
$
2 Date won
3 Type of wager 4
Federal income tax withheld
$
5 Transaction 6 Race
7
Winnings from identical wagers
$
8 Cashier
9
Winner’s taxpayer identification no.
10 Window
11 First I.D. 12 Second I.D.
13
State/Payer’s state identification no.
14 State winnings
$
15 State income tax withheld
$
16 Local winnings
$
17 Local income tax withheld
$
18 Name of locality
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
▶
Date
▶
Form W-2G
www.irs.gov/FormW2G
Instructions for Payer
To complete Form W-2G, use:
• The 2019 General Instructions for Certain Information
Returns, and
• The 2019 Instructions for Forms W-2G and 5754.
To order these instructions and additional forms, go to
www.irs.gov/FormsPubs.
Due dates. Furnish Copies B and C of this form to the
winner by January 31, 2020.
File Copy A of this form with the IRS by
February 28, 2020. If you file electronically, the due date is
March 31, 2020.
Withholding. You may be required to withhold federal
income tax from cash or noncash gambling winnings. See
the 2019 Instructions for Forms W-2G and 5754 for the
rates.
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. Also
see Pub. 515, Withholding of Tax on Nonresident Aliens
and Foreign Entities.
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 2019 Instructions for
Forms W-2G and 5754.
Need help? If you have questions about reporting on Form
W-2G, call the information reporting customer service site
toll free at 866-455-7438 or 304-263-8700 (not toll free). If
you are deaf, hard of hearing, or have a speech disability
and have access to TTY/TDD equipment, you can call
304-579-4827 (not toll free).
Future developments. For the latest information about
developments related to Form W-2G and its instructions,
such as legislation enacted after they were published, go
to www.irs.gov/FormW2G.
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Form W-2G Certain Gambling Winnings 2019

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Completed 27 January 2020

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