Win/Loss Request

Consent*
I confirm and agree that all the information is correct and I am requesting my win/loss statement.
By signing your name below in the signature box, you and Oneida Casino agree that you executed this form with an “electronic signature” in accordance with the ESIGN Act of 2000, and you agree your electronic signature creates a valid and enforceable authorization to complete the transaction requested in this form.
Signature*

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).
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