Win Loss Statement

To create your win loss statement fillout the form details below. Be sure to select your specific property. If you've visited more than one of our properties, you can create an additional win loss statement for that property also.

Property Player ID Birth Month Birth Day Birth Year Win - Loss Year
Gaming Activity - The above information is provided in response to a request by the person shown above. The activity shown above is associated with the player's card only. Hence, no assurance is made that this activity was accumulated by the person named above. The above figure may not be all inclusive of the person's gaming activity and only reflects that information currently available in the Gold Ranch Casino database. Further, the above "Slot or Table Loss" figure may not be an accurate representation of investment.
Tax Form Activity - Original documents were issued to the winning player at the time of the jackpot. The above information is provided as a reference only, as requested by the person above, and is not intended to be used as the substitute tax form reporting gaming winnings.
I agree to the above terms.