Form 8027 Employers Annual Information Return of Tip Income and Al

Form

8027

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

Department of the Treasury
Internal Revenue Service

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OMB No. 1545-0714

2011

See the separate instructions.

Employer identification number

Name of establishment

Check if:
Amended Return
Final Return

Number and street (see instructions)

Type of establishment (check
only one box)

City or town, state, and ZIP code

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)

Establishment number (see
instructions)

Number and street (P.O. box, if applicable)

Apt. or suite no.

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

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

Yes (lines 1 and 2 must be completed)

1

Total charged tips for calendar year 2011

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2

Total charge receipts showing charged tips (see instructions) .

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2

3

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

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3

4a

Total tips reported by indirectly tipped employees

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4a

b Total tips reported by directly tipped employees . . . . . . . . . . . . .
Note. Complete the Employer’s Optional Worksheet for Tipped Employees in the
instructions to determine potential unreported tips of your employees.

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4b

c

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4c

5
6

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

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1

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5

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

6

7

Allocation of tips. If line 6 is more than line 4c, enter the excess here . . . . . . . .
▶ 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
8

No

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Allocation based on good-faith agreement. Attach a copy of the agreement .

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Enter the total number of directly tipped employees at this establishment during 2011

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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 ▶

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

Date ▶
Cat. No. 49989U

Form 8027 (2011)