3232
CORRECTED
OMB No. 1545-0238
PAYER’S name
2 Federal income tax withheld
1 Gross winnings
Street address
4 Date won
3 Type of wager
Certain
Gambling
Winnings
6 Race
5 Transaction
City, state, and ZIP code
Federal identification number
8 Cashier
7 Winnings from identical wagers
For Privacy Act and
Paperwork Reduction Act
Notice, see the 2008
General Instructions for
Forms 1099, 1098, 5498,
and W-2G.
10
Window
WINNER’S name
9 Winner’s taxpayer identification no.
Street address (including apt. no.)
11
First I.D.
12
Second I.D.
City, state, and ZIP code
State/Payer’s state identification no.
14
State income tax withheld
13
File with Form 1096.
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.
Copy A
Date ©
Signature ©
Department of the Treasury - Internal Revenue Service
Form W-2G
Cat. No. 10138V
For Internal Revenue
Service Center
Form W-2G
Telephone number
Note: Form W-2G is printed black & white, not color like the other W-2s.
2008
CORRECTED
OMB No. 1545-0238
2 Federal income tax withheld
1 Gross winnings
4 Date won
3 Type of wager
6 Race
5 Transaction
8 Cashier
7 Winnings from identical wagers
10
Window
9 Winner’s taxpayer identification no.
11
First I.D.
12
Second I.D.
State/Payer’s state identification no.
14
State income tax withheld
13
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.
Date ©
Signature ©
Department of the Treasury - Internal Rev