Request Tax Form

Home Casino Action Players Club Request Tax Form

Tax Form Request

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Players Club Card #

Date of Birth

Year Requested

Email Address

Preferred Delivery Method

TERMS AND CONDITIONS

I hereby certify that I am the person named in this request and all information is true and accurate. By executing this document I hereby request the New Palace Casino LLC, furnish me with the requested win/loss or W2G documentation for my personal use. I hereby agree to indemnify and hold harmless the New Palace Casino LLC, their respective officers, directors, employees and agents from any and all claims, suits, causes of action, liabilities, costs, losses, damages and expenses which I, or any third party, might have or incur as a result of this information. New Palace Casino makes no representation or warranty, express or implied, as to the accuracy of this information or its effectiveness as proof of losses. I understand that it is my own responsibility to maintain accurate records of play, and that the information I am requesting consists of estimates only and may not be appropriate for income tax reporting. Consult your tax advisor if you have questions regarding deducting gaming losses on your tax return.

I understand that it is my responsibility to maintain accurate records of play, and that the information I am requesting consists of estimates only and may not be appropriate for income tax reporting, in consideration of my receipt of this information. I agree to indemnify and hold harmless Palace Casino , it’s subsidiaries and affiliates, and their respective officers, directors, employees and agents from any and all claims, suits, causes of action, liabilities, costs, losses, damages, and expenses (including attorney’s fees and costs) which I, or my administrators, executors, agents, successors, heirs or assigns, or any third party, might have or incur as a result of, or, in any way relating to my receipt and/or use of the information. For more information, contact the IRS or see IRS website:
https://www.irs.gov/newsroom/reporting-gambling-income-and-losses-on-your-tax-return

Statement: Document indicates estimated play activity (win or loss) based upon observable and/or carded gaming activity.

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