Employer’s Annual Information Return of
OMB No. 1545-0714
Tip Income and Allocated Tips
Department of the Treasury
Internal Revenue Service
Type of establishment (check
only one box)
Name of establishment
Use IRS label.
Evening meals only
Number and street (See instructions.)
Employer identification number
Evening and other
please type or
Meals other than eve-
City or town, state, and ZIP code
Number and street (P.O. box, if applicable.)
Apt. or suite no.
City, town or post office, state, and ZIP code (If a foreign address, enter city, province or state, postal code, and country.)
Check the applicable box:
Total charged tips for 1994
Total charged receipts (other than nonallocable receipts) showing charged tips
Total amount of service charges of less than 10% paid as wages to employees
4a Total tips reported by indirectly tipped employees
b Total tips reported by directly tipped employees
c Total tips reported (Add lines 4a and 4b.)
Gross receipts from food or beverage operations (other than nonallocable receipts)
Multiply line 5 by 8% (.08) or the lower rate shown here
granted by the
district director. Attach a copy of the district director’s determination letter to this return
Note: If you have allocated tips using other than the calendar year (semimonthly, biweekly,
quarterly, etc. ), put an X on line 6 and enter the amount of allocated tips from your records
on line 7.
Allocation of tips. If line 6 is more than line 4c, enter the excess here
This amount must be allocated as tips to tipped employees working in this establishment.
Check the box below that shows the method used for the allocation. (Show the portion, if
any, attributable to each employee in box 8 of the employee’s Form W-2.)
a Allocation based on hours-worked method (See instructions for restriction.)
Note: If you checked line 7a, enter the average number of employee hours worked
per business day during the payroll period. (See instructions. )
b Allocation based on gross receipts method
c Allocation based on good faith agreement (Attach copy of agreement.)
Total number of directly tipped employees at this establishment during 1994
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct, and complete.
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 49989U
Printed on recycled paper