Form W-2g - Certain Gambling Winnings - 2018

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3232
VOID
CORRECTED
OMB No. 1545-0238
PAYER’S name, street address, city or town, province or state, country, and
1 Reportable winnings
2 Date won
2018
ZIP or foreign postal code
$
Form W-2G
3 Type of wager
4 Federal income tax withheld
$
Certain
5 Transaction
6 Race
Gambling
Winnings
7 Winnings from identical wagers
8 Cashier
PAYER’S federal identification number
PAYER'S telephone number
$
9 Winner’s taxpayer identification no. 10 Window
For Privacy Act and
Paperwork Reduction
Act
WINNER’S name
11 First I.D.
12 Second I.D.
Notice, see the 2018
General
Instructions for
Certain Information
Street address (including apt. no.)
13 State/Payer’s state identification no. 14 State winnings
Returns.
$
City or town, province or state, country, and ZIP or foreign postal code
15 State income tax withheld
16 Local winnings
File with Form 1096
$
$
17 Local income tax withheld
18 Name of locality
Copy A
For Internal Revenue
Service Center
$
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
W-2G
Form
Cat. No. 10138V
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

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