City or town, province or state, country, and ZIP or foreign
13
OMB No. 1545-0238
PAYER’s name, street address, city or town, province or 
tax withheld in box 4
CORRECTED (if checked)
1
Gross winnings
2
state, country, ZIP or foreign postal code
Federal income tax withheld
2013
Street Address
3
Type of wager
4
Date won
Form W-2G
Certain
City
State
ZIP Code
5
Transaction
6
Race
Gambling
Winnings
Federal ID Number
Telephone Number
7
Winnings from identical wagers
8
Cashier
WINNER’s name
9
Winner’s taxpayer identification no.
10
Window
Street Address (including apt. no.)
11
First I.D.
12
Second I.D.
Copy B
Report this income on
City
State
ZIP Code
State/Payer’s state identification no.
14
State winnings
your federal tax
return. If this form
Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identification number
shows federal income
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.
attach this copy to
Signature
G
Date
G
your return.
Form 
W-2G
Department of the Treasury - Internal Revenue Service
15  
$
16  
$
17  
$
18  
$
$
$
$
State income tax withheld
Local winnings
Local income tax withheld
Name of Locality
postal code
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