Statement by Person(s) Receiving Gambling Winnings
Form 5754                   Recipients of gambling winnings should see the instructions on the back of this form.        OMB No. 1545-0239 
(Rev. November 2024)
Department of the Treasury  Payers of gambling winnings should see the separate Instructions for Forms W-2G and 5754.    Return to payer. Do not  
Internal Revenue Service            Go to www.irs.gov/Form5754 for the latest information.                                     send to the IRS. 
          Date won                  Type of winnings                  Game number                        Machine number        Race number 

Part I    Person to Whom Winnings Are Paid 
                            Name                                                                         Address 
                                                        (number, street, apt. no., city or town, state or province, country, and ZIP or foreign postal code)

Taxpayer identification number                         Other I.D.                                        Amount received Federal income tax withheld 

Part II   Persons to Whom Winnings Are Taxable (continued on page 2) 
          (a) Name               (b) Taxpayer                         (c) Address                                              (e) Winnings from  
                                 identification number (number, street, apt. no., city or town, state or (d) Amount won        identical wagers 
                                                       province, country, and ZIP or foreign postal code)

Under penalties of perjury, I declare that, to the best of my knowledge and belief, the names, addresses, and taxpayer identification numbers that I have furnished correctly  
identify me as the recipient of this payment and correctly identify each person entitled to any part of this payment and any payments from identical wagers. 

Signature                                                                          Date 
For Privacy Act and Paperwork Reduction Act Notice, see back of form.              Cat. No. 12100R                       Form  5754 (Rev. 11-2024) 

Form 5754 (Rev. 11-2024)                                                                                                          Page 2 
Part II     Persons to Whom Winnings Are Taxable (continued from page 1) 
          (a) Name               (b) Taxpayer                 (c) Address                                                    (e) Winnings from  
                              identification number   (number, street, apt. no., city or town, state or (d) Amount won       identical wagers 
                                                    province, country, and ZIP or foreign postal code)

Instructions for Recipient of Gambling                        Privacy Act and Paperwork Reduction Act Notice. We 
                                                              ask for the information on this form to carry out the 
Winnings                                                      Internal Revenue laws of the United States. You are 
Future developments. For the latest information               required to give us the information. We need it to ensure 
about developments related to Form 5754, such as              that you are complying with these laws and to allow us to 
legislation enacted after it was published, go to             figure and collect the right amount of tax. Regulations 
www.irs.gov/Form5754.                                         section 31.3402(q)-1 requires you to furnish an 
                                                              information return to the payer if you receive gambling 
Purpose of form. You must complete Form 5754 if you           winnings either for someone else or as a member of a 
receive gambling winnings either for someone else or as       group of two or more people sharing the winnings, such 
a member of a group of two or more people sharing the         as by sharing the same winning ticket. 
winnings, such as by sharing the same winning ticket.  
The information you provide on the form enables the              You are not required to provide the information  
payer of the winnings to prepare Form W-2G, Certain           requested on a form that is subject to the Paperwork  
Gambling Winnings, for each winner to show the winnings       Reduction Act unless the form displays a valid OMB  
taxable to each.                                              control number. Books or records relating to a form or its  
                                                              instructions must be retained as long as their contents  
Completing the form. If you are the person to whom            may become material in the administration of any Internal  
gambling winnings are paid, enter your name, address,         Revenue law. Generally, tax returns and return  
and taxpayer identification number in Part I. If the          information are confidential, as required by Internal 
winnings are from state-conducted lotteries, the box          Revenue Code section 6103. 
labeled “Other I.D.” may be left blank. The total amount  
received and the total federal income tax withheld must          The time needed to complete this form will vary  
be entered in the remaining columns.                          depending on individual circumstances. The estimated  
                                                              average time is 12 minutes. 
Complete Part II to identify each winner and each  
winner’s share of the winnings. If you are also one of the       If you have comments concerning the accuracy of this  
winners, enter your information first in Part II by entering  time estimate or suggestions for making this form  
“Same as above” in columns (a), (b), and (c) and the          simpler, we would be happy to hear from you. You can 
applicable amounts in columns (d) and (e). Then complete      send us comments from www.irs.gov/FormsComments. 
columns (a) through (e) for each of the other winners.        Or you can send your comments to Internal Revenue 
Return the form to the payer.                                 Service, Tax Forms and Publications Division, 1111  
                                                              Constitution Ave., NW, IR-6526, Washington, DC  20224. 
Taxpayer identification number. The taxpayer                  Don’t send this form to this address. Instead,  return it to 
identification number for an individual is the social         the payer. 
security number or individual taxpayer identification  
number. For all others, it is the employer identification  
number. 
Signature. If federal income tax is withheld, the person  
who receives the winnings must sign and date the form. If 
no federal income tax is withheld, no signature is  
required. 

                                                                                                                       Form  5754 (Rev. 11-2024)