EFTA01222694.pdf

Social Security and Medicare Tax Foc.41 37 on Unreported Tip Income OMB No. 1545-0074 Deparknent of the Treasury lk. Go to www.irs.gov/Form4137 for the latest information. 2017 Attachment as internal Revenue Senna/ 091 llk Attach to Form 1040, Form 1040NR, Form 1040NR-EZ, Form 1040-SS, or Form 1040-PR. Sequence No. Z‘b Name of person who received tips. If married. complete a separate Form 4137 for each spouse with unreported tips. Social security number 1 (a) Name of employer to whom (b) Employer (c) Total cash and charge (d) Total cash and charge you were required to but didn't identification number tips you received (including tips you reported to your report all your Ups (see Instructions) (see Instructions) unreported tips) (see instructions) employer A B C D 2 Total cash and charge tips you received in 2017. Add the amounts from line 1, column (c) 2 3 Total cash and charge tips you reported to your employer(s) in 2017. Add the amounts from line 1, column (d) 3 4 Subtract line 3 from line 2. This amount is income you must include in the total on Form 1040, line 7; Form 1040NR, line 8; or Form 1040NR-EZ, line 3 4 5 Cash and charge tips you received but didn't report to your employer because the total was less than $20 in a calendar month (see instructions) 6 Unreported tips subject to Medicare tax. Subtract line 5 from line 4 7 Maximum amount of wages (including tips) subject to social security tax 7 127.200 00 8 Total social security wages and social security tips (total of boxes 3 and 7 shown on your Forrn(s) W-2) and railroad retirement (RRTA) compensation (subject to 6.2% rate) (see instructions) 9 Subtract line 8 from line 7. If line 8 is more than line 7, enter -0- 10 Unreported tips subject to social security tax. Enter the smaller of line 6 or line 9. If you received tips as a federal, state, or local government employee, see instructions . . . . 10 11 Multiply line 10 by 0.062 (social security tax rate) 11 12 Multiply line 6 by 0.0145 (Medicare tax rate) 12 13 Add lines 11 and 12. Enter the result here and on Form 1040, line 58; Form 1040NR, line 56; or Form 1040NR-EZ, line 16 (Form 1040-SS and 1040-PR filers, see instructions.) . . . 13 For Paperwork Reduction Act Notice. see your tax return instructions. Form 4137 Rom EFTA01222694