Form 8027

Department of the Treasury 

Internal Revenue Service 

Employer's Annual Information Return of 

Tip Income and Allocated Tips

▶ See the separate instructions.

▶ Information about Form 8027 and its separate instructions is available at www.irs.gov/form8027.

OMB No. 1545-0714

2012

Check if:

Amended Return

Final Return

Name of establishment

Number and street (see instructions)

City or town, state, and ZIP code

Employer identification number

Type of establishment (check

only one box)

1 Evening meals only

2 Evening and other 

meals

3 Meals other than 

evening meals

4 Alcoholic beverages

Employer’s name (name as shown on Form 941)

Number and street (P.O. box, if applicable) Apt. or suite no.

City, state, and ZIP code (if a foreign address, see instructions)

Establishment number (see 

instructions)

Does this establishment accept credit cards, debit cards, or other charges? Yes (lines 1 and 2 must be completed) No

1 Total charged tips for calendar year 2012 . . . . . . . . . . . . . . . . . 1 

2 Total charge receipts showing charged tips (see instructions) . . . . . . . . . . . 2 

3 Total amount of service charges of less than 10% paid as wages to employees . . . . . 3 

4 a Total tips reported by indirectly tipped employees . . . . . . . . . . . . . . 4a 

b Total tips reported by directly tipped employees . . . . . . . . . . . . . . . 4b

Note. Complete the Employer’s Optional Worksheet for Tipped Employees in the 

instructions to determine potential unreported tips of your employees.

c Total tips reported (add lines 4a and 4b) . . . . . . . . . . . . . . . . . . 4c 

5 Gross receipts from food or beverage operations (not less than line 2—see instructions) . . 5 

6 Multiply line 5 by 8% (.08) or the lower rate shown here ▶ granted by the IRS.

Attach a copy of the IRS determination letter to this return . . . . . . . . . . . . 6 

Note. If you have allocated tips using other than the calendar year (semimonthly, biweekly, 

quarterly, etc.), mark an “X” on line 6 and enter the amount of allocated tips from your records

on line 7.

7 Allocation of tips. If line 6 is more than line 4c, enter the excess here . . . . . . . . 7 

▶ 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, 

allocated 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 marked the checkbox on 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 a copy of the agreement . . . . .

8 Enter the total number of directly tipped employees at this establishment during 2012 ▶

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.

Signature ▶ Title ▶ Date ▶

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 49989U Form 8027 (2012)