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FORM G16 (Rev. 2002) STATE OF HAWAII DEPARTMENT OF TAXATION CERTIFICATE FOR THE RESALE OF SERVICES BY A LICENSED INTERMEDIARY (PLEASE PRINT OR TYPE) Note: If the transaction does not qualify for the
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Form G-16 Rev Certificate is a tax form used to report income earned from gambling winnings.
Individuals who have received gambling winnings that exceed a certain threshold are required to file Form G-16 Rev Certificate.
Form G-16 Rev Certificate can be filled out by entering all necessary information regarding the gambling winnings received.
The purpose of Form G-16 Rev Certificate is to report taxable gambling income to the IRS.
Information such as the amount of gambling winnings, the date they were received, and any applicable taxes withheld must be reported on Form G-16 Rev Certificate.
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