Win/Loss or Tax Information Request Form at a glance
What it is: The Win/Loss or Tax Information Request Form is a request to provide a statement of activity for the tax year(s).
Who signs: Sign as the Casino Guest's Authorized Signature and enter the Date.
What to bring and attach to Win/Loss or Tax Information Request Form
Provide a copy of your valid ID and your SSN (TIN) number, what applies. If this Information is not obtained, then the request will not be completed.
A filled-in Win/Loss or Tax Information Request Form example: a guest requests a win/loss statement
How to fill out Win/Loss or Tax Information Request Form, box by box
Name, Social Security Number and Date of Birth
Under Name, enter the Last Name, the First Name and the Players Club Card #.
Enter the Social Security Number and the Date of Birth as Month, Day and Year.
Mailing Address, Telephone and E-Mail
Under Mailing Address, enter the Street Address or P.O. Box, the Apartment Number, the City, the State and the Zip.
Enter the Telephone number and the E-Mail if applicable.
Statement of my activity for the tax year(s)
Enter the tax year(s) for the statement of your activity.
Check the document(s): Win/Loss Statement or W2G.
Sites
Check all the Sites that apply; this is for W2G's only.
Certification
You certify that the information and statements contained herein are true and correct and authorize Choctaw Casinos to provide you with the checked statement(s). By signing, you agree to release Choctaw Casinos, its officers, directors, associates, and agents from any loss, cost, expense (including attorney's fees and costs), damages, liability or claims of any kind.
Casino Associate Issuing Copies
The Casino Associate Issuing Copies signs and enters the Date.
More rules for Win/Loss or Tax Information Request Form
1099's can be requested after February 1st for the previous tax year.
All requests for 1099's must be sent to: Choctaw Nation of Oklahoma Finance Department, Attn: Stacey Workman, P.O. 1210 Durant, OK 74701.
Common questions about Win/Loss or Tax Information Request Form
Where do I file it?
Return the form to Choctaw Casino, Attention: Cage Accounting, 3400 Choctaw Rd, Pocola, Ok 74902. Phone: 918-436-7761. Fax: 918-436-7606.
Sources
[1] Choctaw Casinos Win/Loss or Tax Information Request Form (the served file; no issuer file found) (the Official source link on this page).