//1ä1ÝFORM 4137ò SOCIAL SECURITY TAX ON UNREPORTED TIP INCOMEò 1990 * 24ß ãC0*Ýò =OMB No. 1545-0059Ýò-OÝName of person who received tip income:ò |Social Security No.Ýò ;|ß ãC1*ßAãC2*Ýò-OÝName of employers:Ýß îáïÝß îáïÝß îáïÝò=OÝ 1. Total cash and charge tips received in 1990ò.1.|ßEáÝò A|ò- Ý 2. Total cash and charge tips reported to your employerò.2.|ßEáÝò A|ò- Ý 3. Subtract line 2 from line 1. Include on Form 1040, ln 7.....3.|ßEáÝò A|ò- Ý 4. Cash and charge tips received but did not report to yourò |Ý employer because total was less than $20 in a monthò.4.|ßEáÝò A|ò- Ý 5. Subtract line 4 from line 3ò. 5.|ßEáÝò 5ò- |ò- Ý 6. Largest amount subject to social security tax...6.| 51,300.00|Ýò 5|ò- |Ý 7. Total social security wages and tips on W-2s....7.|ò |ß8á Ýò 5|ò- |ò- Ý 8. Subtract line 7 from line 6ò. 8.|ßEá Ýò A|ò- Ý 9. Unreported tips subject to social securityò.9.|ßEá Ýò A|ò- Ý10. Multiply line 9 by .0765. Enter on Form 1040, line 51ò.10.|ßEá Ýò Aò- Ýò=OÝFor Paperwork Reduction Act Notice, see instructionsò Form 4137 (1990)ÝÝ- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ÝÝò-OÝ| SCHEDULE U | U. S. SCHEDULE OF UNREPORTED TIP INCOME |ò 1990 |Ý| (Form 1040) |ò /|ò |Ý|ò-M|Ý| Name of person who received tip income:ò | SSN:ò |Ý|ò 8|ò |ßá ß?áÝ|ò-M|Ý| Address (number and street):ò | Occupation:ò |Ý|ò 3|ò |ßáß:áÝ|ò-M|Ý| City or town, state, and ZIP code:ò *|Ý|ò M|ßáß)áß,áÝ|ò-M|Ý| Unreported tips subject to social security taxò.>>>|ò |ß?áÝ|ò-M|Ý|ò Please do not write in this spaceò |Ý|ò (|ò #|Ý|ò (|ò #|Ý|ò (|ò #|Ý|ò (| DLN --ò |Ýò-OAM Software H838ð//2ä1ôN9041371*ß" XÝÝßF4137ÝÝÝÝÝß ãC1*ßDãC2*ÝÝß áÝÝß áÝÝß áÝÝÝÝßDáÝÝßDáÝÝÝßDáÝÝßDáÝÝßDáÝÝÝÝÝß5á ÝÝßDá ÝÝÝßDá ÝÝßDá ÝÝÝÝÝÝÝÝÝÝÝÝß á ßDáÝÝß áß6áÝÝß áß áß%áÝÝßCáðÿÿÿ