Employer's Annual Information Return of Tip Income and Allocated Tips

Check if:

Name of establishment

Employer identification number

Establishment Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Type of establishment (check only one box)

Employer's name (see instructions)

Establishment number (see instructions)

Employer's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Does this establishment accept credit cards, debit cards, or other charges?

1 Total charged tips for calendar year 2025

2 Total charge receipts showing charged tips (see instructions)

3 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)

5 Gross receipts from food and beverages (not less than line 2-see instructions)

6 Multiply line 5 by 8% (0.08) or the lower rate shown here granted by the IRS. If you use a lower rate, attach a copy of the IRS determination letter to this return

7 Allocation of tips

Allocation Method

8 Enter the total number of directly tipped employees at this establishment during 2025

Under penalties of perjury, I declare that I have examined this return, including accompanying documents, and to the best of my knowledge and belief, it is true, correct, and complete.

Signature

Title

Date