Exhibit 3.11.180-1 shows a sample of Form 8027, Employer's Annual Information Return of Tip Income and Allocated Tips. The location of each transcription (T) line is found by a two-digit element number. A table having the element number, the item description and the location on the Form 8027 follows this exhibit.Top left corner of Form 8027 reads: DRAFTT 01 - Center top area of Form 8027 - block DLNT 02 - Center top area of Form 8027 - serial number of DLNT 24 - Right upper area of Form 8027 - tax yearT 25 - Left of the check boxes for Amended Return and Final Return (as close to that area as possible) - Special Return CodeT 04 - Establishment area - Name of establishmentT 09 - Right upper area of Form 8027 - Employer identification number - EINT 27 - Establishment area - Number and street of establishmentT 05 - Establishment area - City of establishmentT 06 - Establishment area - State of establishmentT 07 - Establishment area - ZIP code of establishmentT 10 - Right upper area of Form 8027 - Type of establishment codeT 08 - Employer area - Employer’s nameT 28 - Employer area - Number and street of employerT 11 - Right of Employer area - Establishment numberT 29 - Employer area - City of employerT 30 - Employer area - Street of employerT 31 - Employer area - ZIP code of employerT 03 - Dotted area of Line 1 - Amended document codeT 12 - Line 1 - Total charged tips for calendar year 2023T 13 - Line 2 - Total charge receipts showing charged tipsT 14 - Line 3 - Total amount of service charges of less than 10 percent paid as wages to employeesT 26 - Center area of Form 8027 - MMDDYY - Received dateT 15 - Line 4a - Total tips reported by indirectly tipped employeesT 16 - Line 4b - Total tips reported by directly tipped employeesT 17 - Line 4c - Total tips reported (add lines 4a and 4b)T 18 - Line 5 - Gross receipts from food and beveragesT 20 - Line 6 (Center area) - Lower rate show here lineT 19 - Line 6 - Multiple line 5 by 8 percentT 21 - Line 7 - Allocation of tipsT 22 - Line 7a, Line 7b, Line 7c - Allocation methodT 23 - Line 8 - Enter the total number of directly tipped employees at this establishment during 2023Signature line - Text box reads: Correspond if signature is missing