Form 5754 Form 5754 Statement by Person(s) Receiving Gambling Winnings

5754

Form
(Rev. November 2024)
Department of the Treasury
Internal Revenue Service

Statement by Person(s) Receiving Gambling Winnings
Recipients of gambling winnings should see the instructions on the back of this form.
Payers of gambling winnings should see the separate Instructions for Forms W-2G and 5754.
Go to www.irs.gov/Form5754 for the latest information.

Date won

Part I

Type of winnings

Machine number

Race number

Person to Whom Winnings Are Paid
Name

Address
(number, street, apt. no., city or town, state or province, country, and ZIP or foreign postal code)

Taxpayer identification number

Part II

Game number

OMB No. 1545-0239
Return to payer. Do not
send to the IRS.

Other I.D.

Amount received

Federal income tax withheld

Persons to Whom Winnings Are Taxable (continued on page 2)
(a) Name

(b) Taxpayer
identification number

(c) Address
(number, street, apt. no., city or town, state or
province, country, and ZIP or foreign postal code)

(e) Winnings from
identical wagers

(d) Amount won

Under penalties of perjury, I declare that, to the best of my knowledge and belief, the names, addresses, and taxpayer identification numbers that I have furnished correctly
identify me as the recipient of this payment and correctly identify each person entitled to any part of this payment and any payments from identical wagers.

Signature

For Privacy Act and Paperwork Reduction Act Notice, see back of form.

Date
Cat. No. 12100R

Form

5754 (Rev. 11-2024)

Page 2

Form 5754 (Rev. 11-2024)

Part II

Persons to Whom Winnings Are Taxable (continued from page 1)
(a) Name

(b) Taxpayer
identification number

(c) Address
(number, street, apt. no., city or town, state or
province, country, and ZIP or foreign postal code)

Instructions for Recipient of Gambling
Winnings
Future developments. For the latest information
about developments related to Form 5754, such as
legislation enacted after it was published, go to
www.irs.gov/Form5754.
Purpose of form. You must complete Form 5754 if you
receive gambling winnings either for someone else or as
a member of a group of two or more people sharing the
winnings, such as by sharing the same winning ticket.
The information you provide on the form enables the
payer of the winnings to prepare Form W-2G, Certain
Gambling Winnings, for each winner to show the winnings
taxable to each.
Completing the form. If you are the person to whom
gambling winnings are paid, enter your name, address,
and taxpayer identification number in Part I. If the
winnings are from state-conducted lotteries, the box
labeled “Other I.D.” may be left blank. The total amount
received and the total federal income tax withheld must
be entered in the remaining columns.
Complete Part II to identify each winner and each
winner’s share of the winnings. If you are also one of the
winners, enter your information first in Part II by entering
“Same as above” in columns (a), (b), and (c) and the
applicable amounts in columns (d) and (e). Then complete
columns (a) through (e) for each of the other winners.
Return the form to the payer.
Taxpayer identification number. The taxpayer
identification number for an individual is the social
security number or individual taxpayer identification
number. For all others, it is the employer identification
number.
Signature. If federal income tax is withheld, the person
who receives the winnings must sign and date the form. If
no federal income tax is withheld, no signature is
required.

(e) Winnings from
identical wagers

(d) Amount won

Privacy Act and Paperwork Reduction Act Notice. We
ask for the information on this form to carry out the
Internal Revenue laws of the United States. You are
required to give us the information. We need it to ensure
that you are complying with these laws and to allow us to
figure and collect the right amount of tax. Regulations
section 31.3402(q)-1 requires you to furnish an
information return to the payer if you receive gambling
winnings either for someone else or as a member of a
group of two or more people sharing the winnings, such
as by sharing the same winning ticket.
You are not required to provide the information
requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form or its
instructions must be retained as long as their contents
may become material in the administration of any Internal
Revenue law. Generally, tax returns and return
information are confidential, as required by Internal
Revenue Code section 6103.
The time needed to complete this form will vary
depending on individual circumstances. The estimated
average time is 12 minutes.
If you have comments concerning the accuracy of this
time estimate or suggestions for making this form
simpler, we would be happy to hear from you. You can
send us comments from www.irs.gov/FormsComments.
Or you can send your comments to Internal Revenue
Service, Tax Forms and Publications Division, 1111
Constitution Ave., NW, IR-6526, Washington, DC 20224.
Don’t send this form to this address. Instead, return it to
the payer.

Form

5754 (Rev. 11-2024)