Michigan Win Loss Statement Form PDF Details

Have you recently moved to Michigan and need to understand how taxes work? Whether you're a new resident or have called this state home for years, it's important that you familiarize yourself with the requirements of filing your taxes. Specifically, a form called the Michigan Win Loss Statement will determine which factors from winnings are taxable and must be reported as income. In this blog post we'll walk through everything you need to know about completing a Michigan Win Loss Statement correctly.

QuestionAnswer
Form NameMichigan Win Loss Statement Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdetroit mi win loss statement, mlife win loss statement 2019, mgm grand detroit win loss statement, mi win loss statement

Form Preview Example

Win Loss Statement Request

In order for Grand Traverse Resort and Casinos to release this information each customer is required to submit a signed request. Husband and Wife may use one form. The win loss statements are only available for Player’s Club Card members. Grand Traverse Resort and Casinos does not track play that is not associated with a customers player’s card account

Please provide me with a Win/Loss Statement for Year (s) _________

Name _________________________________________________

Player’s Card Number: _______________________

SS# ___________________________________________________

Date of Birth: _______________________________

Mailing Address ______________________________________________________________________________________

City/State/Zip: ________________________________________________________________________________________

Phone Number (___) _______________________ Email statement to __________________________________________

By signing below the patron hereby releases Grand Traverse Resort and Casinos, its officers, directors, employees, agents from and against any loss, cost, expense (including attorney’s fees and costs, damages, liability or clams of any kind. Additionally, patron hereby agrees to indemnify Grand Traverse Resort and Casinos for, from and against any loss, cost, expense (including attorney’s fees and costs), damages, liability or claims of any kind related to releasing this information. The undersigned acknowledges that the information being provided is based on player tracking information which includes only the play when the undersigned’s players card was connected to the system, and may not accurately reflect the amount of the undersigned’s play since the undersigned can play when the card is not connected to the system and is derived from a system that does not verify the identity of the person using the player card and may include estimated amounts to correct human error in inputting information.

Account Holder’s Signature ______________________________ Date____________________

***********************************************************************************************

Please provide me with a Win/Loss Statement for Year (s) _________

Name _________________________________________________

Player’s Card Number: _______________________

SS# ___________________________________________________

Date of Birth: _______________________________

Mailing Address ______________________________________________________________________________________

City/State/Zip: ________________________________________________________________________________________

Phone Number (___) _______________________ Email statement to ___________________________________________

By signing below the patron hereby releases Grand Traverse Resort and Casinos, its officers, directors, employees, agents from and against any loss, cost, expense (including attorney’s fees and costs, damages, liability or clams of any kind. Additionally, patron hereby agrees to indemnify Grand Traverse Resort and Casinos for, from and against any loss, cost, expense (including attorney’s fees and costs), damages, liability or claims of any kind related to releasing this information. The undersigned acknowledges that the information being provided is based on player tracking information which includes only the play when the undersigned’s players card was connected to the system, and may not accurately reflect the amount of the undersigned’s play since the undersigned can play when the card is not connected to the system and is derived from a system that does not verify the identity of the person using the player card and may include estimated amounts to correct human error in inputting information.

Account Holder’s Signature ______________________________

Date____________________

Only complete official request forms will be accepted for processing. (Must include a copy of Driver’s License OR enter your social security number for verification purposes or request (s) will not be processed). Statements will be processed after the first of the New Year unless specifically requested. Return form via mail, email or drop off at either Casino.

Grand Traverse Resort and Casinos

 

Attn: Shirley Shananaquet, CMP Administrator

 

7741 M-72 East, Williamsburg, MI 49690

 

Office 231-534-8840

email: Shirley.Shananaquet@gtbindians.com