Win/Loss Statement and Tax Information Request Form at a glance
What it is: The Win/Loss Statement and Tax Information Request Form is the form each guest signs and submits so Downstream Casino Resort can release the tax information.
Where to get it: To get this form, visit the Q Club Booth and request a form in person, download the form from DownstreamCasino.com website and follow the instructions, or call (918) 919-6000 and request that a form be sent to the guest (name and address required).
A filled-in Win/Loss Statement and Tax Information Request Form example: a guest requests a Win/Loss Statement
How to fill out Win/Loss Statement and Tax Information Request Form, box by box
First & Last Name, Players Club Card #, Social Security Number and Date of Birth
Name - First and Last Name. Please print legibly. One form per person.
Players Club Card Number - Current Players Club Card Number must be provided for Win/Loss Statements. There should only be one account per person.
Social Security Number - The SS# for the person requesting the tax statement. Date of Birth - The date of birth of the person requesting the tax statement.
Mailing Address, City, State, Zip, Telephone and Email
Mailing Address - Please verify the most current mailing address. City/State/Zip - Complete city, state, and zip code information. Telephone Number - Current telephone number where the guest can be reached.
Email Address - This is optional for the customer but must be provided if the requestor is wanting the tax statement emailed.
Tax year(s) and the documents you wish to receive
Statement Request - Indicate the gaming activity year(s) and the type of tax statement the guest is requesting.
Please provide me with a statement of my activity for the tax year(s). Check the documents you wish to receive: Win/Loss Statement (Players Club Card # Required for this Statement), W2G (Jackpot Winnings), 1099 Gaming (Promotional Winnings - Ex. Hot Seat Drawings, etc.)
Guest's Authorized Signature and the Notary Public
By signing you certify that the information and statements contained herein are true and correct.
I hereby authorize Downstream Development Authority DBA Downstream Casino Resort to provide me with the checked statement(s).
By signing, I agree to release Downstream Development Authority DBA Downstream Casino Resort, its officers, directors, employees, and agents from and against any loss, cost, expense (including attorney's fees and costs), damages liability or claims of any kind. I agree to indemnify Downstream Development Authority DBA Downstream Casino Resort from and against any and all suits, causes of action, liabilities, costs, losses, damages, and attorney's fees and costs which I or my spouse, administrators, executors, agents, assignees or any third party may have arising out of or relating to this request.
I have executed this request at City, State, on this day of, 20, Guest's Authorized Signature. If this form is not presented in person, the signature must be Notarized. SUBSCRIBED AND SWORN TO before me this day of, 20, Notary Public.
If the Players Club account holder is present at the Casino requesting a Tax Statement, the Casino Representative is required to obtain proper identification (driver's license, passport, alien registration, military ID, foreign ID, or valid state or federal ID) to review the picture ID, signature, and verify the guest's Social Security Number.
More rules for Win/Loss Statement and Tax Information Request Form
Only official request forms will be accepted for processing. Letters, telephone calls, or facsimile will not be accepted.
Please Print Legible to Read. Failure to do so may result in your request not being processed.
Common questions about Win/Loss Statement and Tax Information Request Form
Does it need a notary?
If the Players Club account holder is not present at the Casino and requesting a Tax Statement, the form may be mailed, faxed, or emailed. However, if the form is not presented in person by the Players Club account holder, the account holder's signature must be notarized.
Who signs it?
The Win/Loss Statement and Tax Information Request Form must be signed by the Players Club account holder in order to be processed.
Where do I file it?
Email the form to winloss@downstreamcasino.com, or mail the form to Downstream Casino Resort, Attention: Accounting, 69300 East Nee Road, Quapaw, OK 74363. Fax # (918) 919-6100.
When is this form not the right one?
The tax statement request is only available for Players Club Card Members and those individuals who had W2G or 1099 gambling winnings. Downstream Casino Resort does not track play that is not associated with a guest's Players Club Card account.
Sources
[1] Win/Loss Statement and Tax Information Request Form, Downstream Casino Resort (the Official source link on this page).