3232

VOID

CORRECTEDPAYER’S name, street address, city or town, state or province, country,and ZIP or foreign postal code

1 Reportable winnings

2 Date won$
3 Type of wager

4 Federal income tax withheld$

PAYER’S TIN

PAYER’S telephone no.

5 Transaction

6 Race7 Winnings from identical wagers

8 CashierOMB No. 1545-0238

Form W-2G
Certain
GamblingWinnings(Rev. December 2023)
For calendar year20$
9 WINNER’S TIN

10 Window

WINNER’S name

11 First identification no.

12 Second identification no.

Street address (including apt. no.)13 State/Payer’s state identification no. 14 State winnings

City or town, state or province, country, and ZIP or foreign postal code

15 State income tax withheld

16 Local winnings$$

17 Local income tax withheld

18 Name of locality

For Privacy Act
and Paperwork
Reduction Act
Notice, see thecurrent General
Instructions for
Certain Information
Returns.

$
File with Form 1096

Copy AFor 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 furnishedcorrectly 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:
Form W-2G (Rev. 12-2023)

Date:
Cat. No. 10138V

www.irs.gov/FormW2G

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

VOID

CORRECTEDPAYER’S name, street address, city or town, state or province, country,and ZIP or foreign postal code

1 Reportable winnings

2 Date won$
3 Type of wager

4 Federal income tax withheld$

PAYER’S TIN

PAYER’S telephone no.

5 Transaction

6 Race7 Winnings from identical wagers

8 CashierOMB No. 1545-0238

Form W-2GCertain
GamblingWinnings(Rev. December 2023)
For calendar year20$
9 WINNER’S TIN

10 Window

WINNER’S name

11 First identification no.

12 Second identification no.

Street address (including apt. no.)13 State/Payer’s state identification no. 14 State winnings

City or town, state or province, country, and ZIP or foreign postal code

15 State income tax withheld

Copy 1$For State, City,or Local Tax
Department

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 furnishedcorrectly 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:
Form W-2G (Rev. 12-2023)

Date:
www.irs.gov/FormW2G

Department of the Treasury - Internal Revenue Service

CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country,
and ZIP or foreign postal code

1 Reportable winnings

2 Date won$
3 Type of wager

4 Federal income tax withheld$

PAYER’S TIN

PAYER’S telephone no.

5 Transaction

6 Race7 Winnings from identical wagers

8 CashierForm W-2GCertain
GamblingWinnings(Rev. December 2023)
For calendar year20$
9 WINNER’S TIN

10 Window

WINNER’S name

11 First identification no.

12 Second identification no.

Street address (including apt. no.)13 State/Payer’s state identification no. 14 State winnings$
City or town, state or province, country, and ZIP or foreign postal code

OMB No. 1545-0238

15 State income tax withheld

16 Local winnings$$

17 Local income tax withheld

18 Name of locality$

This information
is being furnishedto the IRS.

Copy B
Report this incomeon your federal tax
return. If this formshows federal
income tax
withheld in box 4,attach this copy
to your return.

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 furnishedcorrectly 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:
Form W-2G (Rev. 12-2023)

Date:
www.irs.gov/FormW2G

Department of the Treasury - Internal Revenue Service

CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country,
and ZIP or foreign postal code

1 Reportable winnings

2 Date won$
3 Type of wager

4 Federal income tax withheld$

PAYER’S TIN

PAYER’S telephone no.

5 Transaction6 Race

7 Winnings from identical wagers

8 CashierOMB No. 1545-0238

Form W-2G
CertainGamblingWinnings(Rev. December 2023)
For calendar year20$
9 WINNER’S TIN

10 Window

WINNER’S name

11 First identification no.

12 Second identification no.

Street address (including apt. no.)13 State/Payer’s state identification no. 14 State winnings

City or town, state or province, country, and ZIP or foreign postal code

15 State income tax withheld$
16 Local winnings$$

17 Local income tax withheld

18 Name of locality

This is important tax
information and isbeing furnished tothe IRS. If you arerequired to file areturn, a negligencepenalty or othersanction may be
imposed on you if
this income istaxable and theIRS determinesthat it has notbeen reported.

Copy CFor Winner’s Records$

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 furnishedcorrectly 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:
Form W-2G (Rev. 12-2023)

Date:
www.irs.gov/FormW2G

Department of the Treasury - Internal Revenue ServiceInstructions to WinnerBox 1. The payer must furnish a Form W-2G to you if you
receive:
1. $1,200 or more in gambling winnings from bingo orslot 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 thewager; or5. Any other gambling winnings subject to federal
income tax withholding.
Generally, report all gambling winnings under the “Otherincome” line of Schedule 1 (Form 1040). You can deduct
gambling losses as an itemized deduction, but you cannot
deduct more than your winnings. Keep an accurate recordof your winnings and losses, and be able to prove thoseamounts with receipts, tickets, statements, or similar items
that you have saved. For additional information, see Pub.
529 and Pub. 525.

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 taxpayer identification number (TIN) tothe payer.
Include the amount shown in box 4 on your Form 1040
or 1040-SR as federal income tax withheld. See Pub. 505
for additional information.
Signature. You must sign Form W-2G if you are the onlyperson 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 if another person isentitled to any part of these winnings. Give Form 5754 tothe payer, who will use Form 5754 to prepare Form W-2G
for each person listed as a winner.
Future developments. For the latest information aboutdevelopments related to Form W-2G and its instructions,such as legislation enacted after they were published, go
to www.irs.gov/FormW2G.

CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country,and ZIP or foreign postal code

1 Reportable winnings

2 Date won$
3 Type of wager

4 Federal income tax withheld$

PAYER’S TIN

PAYER’S telephone no.

WINNER’S name

5 Transaction

6 Race7 Winnings from identical wagers

8 CashierOMB No. 1545-0238

Form W-2GCertain
GamblingWinnings(Rev. December 2023)
For calendar year20$
9 WINNER’S TIN

10 Window

11 First identification no.

12 Second identification no.

Street address (including apt. no.)13 State/Payer’s state identification no. 14 State winnings

City or town, state or province, country, and ZIP or foreign postal code

15 State income tax withheld$
16 Local winnings$$

17 Local income tax withheld

18 Name of locality

Copy 2
Attach this copy
to your state,city, or
local income
tax return,if required.

$
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 furnishedcorrectly 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:
Form W-2G (Rev. 12-2023)

Date:
www.irs.gov/FormW2G

Department of the Treasury - Internal Revenue ServiceVOID

CORRECTEDPAYER’S name, street address, city or town, state or province, country,
and ZIP or foreign postal code

1 Reportable winnings

2 Date won$
3 Type of wager

4 Federal income tax withheld$

PAYER’S TIN

PAYER’S telephone no.

5 Transaction

6 Race7 Winnings from identical wagers

8 CashierOMB No. 1545-0238

Form W-2GCertainGamblingWinnings(Rev. December 2023)
For calendar year20$
9 WINNER’S TIN

10 Window

WINNER’S name

11 First identification no.

12 Second identification no.

Street address (including apt. no.)13 State/Payer’s state identification no. 14 State winnings

City or town, state or province, country, and ZIP or foreign postal code

15 State income tax withheld$

For Privacy Actand Paperwork
Reduction Act
Notice, see thecurrent General
Instructions for
Certain Information
Returns.

16 Local winnings$$

17 Local income tax withheld

18 Name of locality

Copy DFor Payer$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 furnishedcorrectly 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:
Form W-2G (Rev. 12-2023)

Date:
www.irs.gov/FormW2G

Department of the Treasury - Internal Revenue Service

Instructions for Payer
To complete Form W-2G, use:
• The current General Instructions for Certain Information
Returns, and• The current Instructions for Forms W-2G and 5754.
To order these instructions and additional forms, go towww.irs.gov/OrderForms.
Filing and furnishing. For filing and furnishing instructions,
including due dates, and to request filing or furnishingextensions, see the current General Instructions for Certain
Information Returns.
Withholding. You may be required to withhold federal
income tax from cash or noncash gambling winnings. See
the current Instructions for Forms W-2G and 5754 for more
information, including the withholding rates.

Foreign winners. Use Form 1042-S to report gambling
winnings paid to nonresident aliens and foreigncorporations. See the Instructions for Form 1042-S andPub. 515 for more information.
Form 5754. If the person receiving the winnings is not theactual winner or is a member of a group of winners, see
Specific Instructions for Form 5754 in the current
Instructions for Forms W-2G and 5754.
Need help? If you have questions about reporting on Form
W-2G, call the Technical Services Operation (TSO) toll freeat 866-455-7438 or 304-263-8700 (not toll free). Deaf or
hard-of-hearing customers may call any of our toll-freenumbers using their choice of relay service.
Future developments. For the latest information aboutdevelopments related to Form W-2G and its instructions,such as legislation enacted after they were published, go
to www.irs.gov/FormW2G.