Form 4070 - Employee'S Report Of Tips To Employer - 2005
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14070
Employee's Report
Form
of Tips to Employer
(Rev. August 2005)
OMB No. 1545-0074
Department of the Treasury
Internal Revenue Service
Employee's name and address
Social security number
1 Cash tips received
0.00
Employer's name and address (include establishment name, if different)
2 Credit and debit card tips received
0.00
3 Tips paid out
0.00
Month or shorter period in which tips were received
4 Net tips (lines 1 + 2 - 3)
from
,
, to
,
0.00
Signature
Date
4070
For Paperwork Reduction Act Notice, see the instructions on the
Form
(Rev. 8-2005)
back of this form.
(HTA)
4070A
Employee's Daily Record of Tips
Form
(Rev. August 2005)
OMB No. 1545-0074
This is a voluntary form provided for your convenience.
Department of the Treasury
See instructions for records you must keep.
Internal Revenue Service
Employee's name and address
Employer's name
Month and year
Establishment name (if different)
Date
Date
a. Tips received directly
b. Credit and debit
c. Tips paid out to
d. Names of employees to whom you
tips
of
from customers and
card tips received
other employees
paid tips
rec'd
entry
other employees
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
0.00
0.00
0.00
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.
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