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Get and Sign W2g Form 2021-2022
Window
WINNER’S name
11 First identification
12 Second identification
Street address (including apt. no.)
13 State/Payer’s state identification no. 14 State winnings
City or town, province or state, country, and ZIP or foreign postal code
15 State income tax withheld
16 Local winnings
$
$
17 Local income tax withheld
18 Name of locality
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
current General
Instructions for
Certain Information
Returns.
$
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