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Tion 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. City, state, and ZIP code 13 State/Payer s state identification no. 14 State income tax withheld OMB No. 1545-0238 Certain Gambling Winnings For Paperwork Reduction Act Notice and instructions for completing this form, see Instructions for Forms 1099, 1098, 5498, and W-2G. File with Form 1096. Un.

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