pdf2json/test/data/fd/form/FW2G.content.txt

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Form W-2G
20
13
Certain 
 Gambling 
 Winnings
Copy C 
 
For Winner's Records
Department of the Treasury - Internal Revenue Service
This is important tax 
information and is 
being 
furnished to the 
Internal 
Revenue Service. If 
you are required to 
file a return, a 
negligence penalty or 
other sanction may 
be imposed on you if 
this income is taxable 
and the IRS 
determines that 
it has not been 
reported.
OMB No. 1545-0238
CORRECTED (if checked)
Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identificat
ion 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 enti
tled to any part of these payments.
Signature
 
a
Date
 
a
Form 
W-2G
www.irs.gov/w2g
PAYER’S name, street address, city or town, province or state, country, ZIP 
or foreign postal code
Federal identification number                Telephone number
WINNER’S name
Street address (including apt. no.)
City or town, province or state, country, and ZIP or foreign postal  code
1  
Gross winnings
$
2  
Date won
3  
Type of wager
4  
Federal income tax withheld
$
5  
Transaction
6  
Race
7  
Winnings from identical wagers
$
8  
Cashier
9  
Winner’s taxpayer identification no.
10  
Window
11  
First I.D.
12  
Second I.D.
13  
State/Payer’s state identification no.
14 
 State winnings
$
15  
State income tax withheld
$
16  
Local winnings
$
17  
Local income tax withheld
$
18  
Name of locality
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