Department of the Treasury
Internal Revenue Service
Employer's Annual Information Return of
Tip Income and Allocated Tips
See the separate instructions.
Information about Form 8027 and its separate instructions is available at www.irs.gov/form8027.
OMB No. 1545-0714
Name of establishment
Number and street (see instructions)
City or town, state, and ZIP code
Employer identification number
Type of establishment (check
only one box)
1 Evening meals only
2 Evening and other
3 Meals other than
4 Alcoholic beverages
Employer’s name (name as shown on Form 941)
Number and street (P.O. box, if applicable)Apt. or suite no.
City, state, and ZIP code (if a foreign address, see instructions)
Establishment number (see
Does this establishment accept credit cards, debit cards, or other charges?
Yes (lines 1 and 2 must be completed)No
1 Total charged tips for calendar year 2016 .................1
2 Total charge receipts showing charged tips (see instructions) ...........2
3 Total amount of service charges of less than 10% paid as wages to employees .....3
4 a Total tips reported by indirectly tipped employees ..............4a
b Total tips reported by directly tipped employees ...............4b
Note: Complete the Employer’s Optional Worksheet for Tipped Employees in the
instructions to determine potential unreported tips of your employees.
c Total tips reported (add lines 4a and 4b) ..................4c
5 Gross receipts from food and beverages (not less than line 2—see instructions) .....5
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 .....
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 yourrecords
on line 7.
7 Allocation of tips. If line 6 is more than line 4c, enter the excess here ........7
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
hoursworked per business day during the payroll period. (see instructions)
b Allocation based on gross receipts method ................
c Allocation based on good-faith agreement ................
8 Enter the total number of directly tipped employees at this establishment during 2016
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
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 49989U
Form 8027 (2016)