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Get Oneida Casino Win/Loss Statement Request Form

Win/Loss Statements are available to Fun Club Members. In order for Oneida Casino to process a Win/Loss Statement this Request Form is required. This form must be completed and signed by the Fun Club Member requesting the information. A Win/Loss Statement will be returned to the Fun Club Member by mail. Please allow 7 days 14 days during tax time to process your request. Thank you. PLEASE PRINT WHEN COMPLETING THIS FORM. Tax Year Requested Name Players Club Acct* Street Address City State Zip Date of Birth Email Phone Fax Customer Signature Date Drivers License or Social Security Must provide DL or SS for verification process Players Club Employee verifying information Mail to Oneida Casino/Fun Club PO Box 365 Oneida WI 54155 Disclaimer Gaming losses in any year may be deducted on your taxes to the extent of reporting winnings in that year. The burden of substantiating losses is upon the customer/player. This statement is provided to assist the customer/player in substantiating losses. The Oneida Tribe of Indians of Wisconsin and its Bingo and Casino operations assumes no liability with regard to the accuracy of the customer/player s losses the identity of the person using the card or any other aspect of this statement. The responsibility of substantiating any losses rests with the individual taxpayer. The Internal Revenue Service IRS may require additional documentation from the taxpayer when losses are claimed* Please review the appropriate IRS regulations and consult with a competent professional when preparing tax returns 26 USC sec* 6001 Proc 77-29. Thank you. PLEASE PRINT WHEN COMPLETING THIS FORM. Tax Year Requested Name Players Club Acct* Street Address City State Zip Date of Birth Email Phone Fax Customer Signature Date Drivers License or Social Security Must provide DL or SS for verification process Players Club Employee verifying information Mail to Oneida Casino/Fun Club PO Box 365 Oneida WI 54155 Disclaimer Gaming losses in any year may be deducted on your taxes to the extent of reporting winnings in that year. The burden of substantiating losses is upon the customer/player. This statement is provided to assist the customer/player in substantiating losses. The burden of substantiating losses is upon the customer/player. This statement is provided to assist the customer/player in substantiating losses. The Oneida Tribe of Indians of Wisconsin and its Bingo and Casino operations assumes no liability with regard to the accuracy of the customer/player s losses the identity of the person using the card or any other aspect of this statement. The Oneida Tribe of Indians of Wisconsin and its Bingo and Casino operations assumes no liability with regard to the accuracy of the customer/player s losses the identity of the person using the card or any other aspect of this statement. The responsibility of substantiating any losses rests with the individual taxpayer. The Internal Revenue Service IRS may require additional documentation from the taxpayer when losses are claimed* Please review the appropriate IRS regulations and consult with a competent professional when preparing tax returns 26 USC sec* 6001 Proc 77-29. .

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