Employer’s Annual Information Return of                                                    OMB No. 1545-0714
Form  8027                                       Tip Income and Allocated Tips
Department of the Treasury                                        ▶ See the separate instructions. 
Internal Revenue Service           ▶ Go to www.irs.gov/Form8027 for instructions and the latest information.                           2021
                           Name of establishment                                                                          Employer identification number

Check if:                  Number and street (don’t enter a P.O. box). See instructions.                                  Type of establishment (check 
Amended Return                                                                                                            only one box)
Final Return               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 (see instructions)                                                                                        Establishment number (see 
                                                                                                                          instructions)
Number and street (or P.O. box number, if mail isn’t delivered to street address)                        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)            No

1     Total charged tips for calendar year 2021  .                  . . .         . . .  . . . .   . . . . .      .       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 
6     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  .           . .      .       6 
      Note:  If  you  have  allocated  tips  using  a  period  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     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 
      hours worked 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 2021  ▶
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 
complete.

Signature ▶                                                             Title ▶                                     Date ▶
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.                       Cat. No. 49989U               Form 8027 (2021)