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Connecticut Wage Tip Form
$5.78
in 2015.
If employed as a bartender, I have received gratuities in the amount of 15.6% of the
minimum wage of $8.70 per hour in 2014 and 18.5% of $9.15 per hour in 2015. My
guaranteed wage is $7.34 per hour in 2014 and $7.46 in 2015.
(Please attach to IRS Form 4070 for reporting tips, if applicable).
Signed:
Date:
Connecticut Department of Labor
Wage & Workplace Standards Division
Tip Statement
I,
, state that as a “Service Employee” under the Restaurant Wage
Order whose duties relate...
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