Blank Michigan Win Loss Statement PDF Form

Blank Michigan Win Loss Statement PDF Form

The Michigan Win Loss Statement form is a request document that allows members of the Player’s Club Card at Grand Traverse Resort and Casinos to obtain their gambling win/loss information. To access this information, customers must submit a signed request, which can be done using a single form for both spouses. It is important to note that only play associated with a Player’s Club Card is tracked and reported.

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The Michigan Win Loss Statement form is an important document for members of the Player’s Club at Grand Traverse Resort and Casinos. This form allows players to request a summary of their gaming activity, specifically detailing their wins and losses over a specified year. To initiate this process, customers must fill out a signed request, which can be completed by both individuals and couples using a single form. It’s crucial to note that only those who hold a Player’s Club Card can access these statements, as the casino does not track play that is not linked to a player’s card account. The form requires essential information, including the player’s name, card number, Social Security number, and date of birth, ensuring that the request is properly verified. Additionally, patrons must acknowledge that the information provided is based on player tracking data, which may not reflect all gaming activity, especially if the card was not in use during play. By signing the form, players also release the casino from any liability related to the provided information. Complete requests must include a copy of a driver’s license or Social Security number for verification, and only official forms will be processed. Players can submit their requests via mail, email, or in person, making it convenient to obtain this important financial documentation.

Document Sample

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: [email protected]

File Specifics

Fact Name Details
Submission Requirement A signed request is mandatory for customers to receive their Win Loss Statement from Grand Traverse Resort and Casinos.
Joint Requests Husbands and wives may submit a single form to request their Win Loss Statements.
Eligibility Only members of the Player’s Club Card can obtain Win Loss Statements.
Tracking Limitations The casino does not monitor play that is not linked to a customer's Player’s Card account.
Information Accuracy The Win Loss Statement reflects only the play associated with the Player’s Card and may not represent total gambling activity.
Processing Time Requests will be processed after the New Year unless a specific date is requested.
Governing Law The request form is governed by Michigan state laws related to gambling and privacy.

How to Use Michigan Win Loss Statement

To obtain your Michigan Win Loss Statement, you will need to fill out the designated form accurately. This process is straightforward, but it is essential to follow each step carefully to ensure your request is processed without delay. After completing the form, you can submit it via mail, email, or in person at the casino.

  1. Begin by entering the year or years for which you are requesting the Win/Loss Statement in the designated space.
  2. Fill in your full name as it appears on your Player’s Club Card.
  3. Provide your Player’s Card Number in the appropriate field.
  4. Enter your Social Security Number for verification purposes. If you prefer, you can also include a copy of your Driver’s License instead.
  5. Input your date of birth in the specified area.
  6. Complete your mailing address, including street, city, state, and zip code.
  7. Provide your phone number, including the area code.
  8. Specify the email address where you would like the statement to be sent.
  9. Sign the form to release Grand Traverse Resort and Casinos from any liability related to the information provided.
  10. Date your signature to confirm the request.

Once the form is completed, ensure that you have included any required identification. Then, submit your request to the Grand Traverse Resort and Casinos through your preferred method. Statements will be processed after the New Year unless otherwise specified in your request.

Your Questions, Answered

What is the Michigan Win Loss Statement form?

The Michigan Win Loss Statement form is a request document that allows members of the Player’s Club at Grand Traverse Resort and Casinos to obtain a record of their gambling activity. This statement includes information about wins and losses associated with the player’s card. It is important to note that the casino only tracks play linked to a player’s card, meaning any play not connected to the card will not be reflected in the statement.

Who is eligible to request a Win Loss Statement?

Only members of the Player’s Club at Grand Traverse Resort and Casinos can request a Win Loss Statement. Both individuals and couples (husband and wife) may use a single form for their request. To ensure eligibility, customers must provide their Player’s Card number along with personal identification information such as their Social Security number or a copy of their driver’s license.

How do I submit my request for a Win Loss Statement?

To submit a request, follow these steps:

  1. Complete the Win Loss Statement form, providing all required information.
  2. Sign the form to release the casino from any liability regarding the provided information.
  3. Include a copy of your driver’s license or your Social Security number for verification.
  4. Return the completed form via mail, email, or drop it off at the casino.

Make sure to send the form to the attention of Shirley Shananaquet, CMP Administrator, at the address provided in the form. Statements will be processed after the first of the New Year unless otherwise specified in your request.

How is the information in the Win Loss Statement calculated?

The information in the Win Loss Statement is based on player tracking data. This data reflects only the gambling activity when the player’s card was active and connected to the system. It may not accurately represent the total amount of play, as any activity not linked to the card will not be included. Additionally, the system may include estimated amounts to correct for human error in data entry.

Common mistakes

  1. Failing to provide the Player’s Card Number. This number is essential for locating your account information.

  2. Not signing the form. A signature is required to authorize the release of your win/loss statement.

  3. Omitting the Social Security Number or a copy of the Driver’s License. Either is necessary for verification purposes.

  4. Providing an incorrect or incomplete Mailing Address. Ensure that all address details are accurate to receive your statement.

  5. Neglecting to indicate the Year(s) for which the statement is requested. This information is critical for processing your request.

  6. Using a form for multiple individuals without noting that Husband and Wife may use one form. Ensure clarity if submitting for both parties.

  7. Not providing a valid Phone Number. A contact number is necessary in case there are questions regarding your request.

  8. Failing to request the statement in a timely manner. Statements are processed after the first of the New Year unless specified otherwise.

  9. Not including an Email Address for electronic statements. If you prefer to receive your statement via email, this must be provided.

  10. Ignoring the instructions for submission. Ensure you return the form via mail, email, or drop-off at the casino as specified.

Documents used along the form

The Michigan Win Loss Statement form serves as a vital tool for players at Grand Traverse Resort and Casinos, allowing them to request a summary of their gaming activity linked to their Player’s Club Card. However, several other forms and documents often accompany this request, ensuring that patrons have all necessary information for accurate processing. Below is a list of these documents, each playing a specific role in the overall procedure.

  • Player’s Club Membership Application: This form is essential for individuals who wish to join the Player’s Club. It collects personal information necessary for account creation and enables players to earn rewards based on their gaming activity.
  • Identification Verification Form: To comply with legal requirements, this document verifies the identity of the patron. It typically requires a copy of a government-issued ID, such as a driver’s license or passport.
  • Tax Form W-2G: This form is issued to players who have won a certain amount in gambling winnings. It reports the income to the IRS and is crucial for tax purposes, ensuring that winnings are accurately reported.
  • Request for Account History: This document allows patrons to request a detailed history of their gaming activity. It may include information on deposits, withdrawals, and other transactions associated with their Player’s Club account.
  • Privacy Policy Acknowledgment: This form outlines how the casino will handle personal information. Patrons must acknowledge understanding of the policy, ensuring transparency regarding data usage and privacy rights.
  • Gambling Self-Exclusion Form: This form is for individuals who wish to voluntarily exclude themselves from gambling activities. It is an important tool for responsible gaming, allowing players to take control of their gambling habits.
  • Customer Feedback Form: After the gaming experience, patrons can provide feedback through this form. It helps the casino improve services and address any concerns that players may have encountered during their visit.

Understanding these accompanying documents enhances the overall experience for patrons at Grand Traverse Resort and Casinos. Each form serves a distinct purpose, ensuring compliance with regulations and fostering responsible gaming practices. By being informed, players can navigate the process more effectively and enjoy their time at the casino with greater peace of mind.

Similar forms

The Michigan Win Loss Statement form shares similarities with a tax return form. Both documents require personal information, such as name, address, and Social Security number. Just as taxpayers must sign their returns to confirm accuracy and authenticity, individuals must also sign the Win Loss Statement to authorize its release. Each document serves as a record of financial activity, with the tax return detailing income and deductions, while the Win Loss Statement summarizes gambling wins and losses. Both documents can be used for financial planning and reporting purposes.

Another document that resembles the Michigan Win Loss Statement is the bank statement. Bank statements provide a summary of transactions, including deposits and withdrawals, much like the Win Loss Statement summarizes gambling activity. Both documents are essential for tracking financial behavior over a specific period. Customers can use bank statements to verify their financial status, while the Win Loss Statement helps gamblers assess their gaming performance. Each document requires accuracy and often serves as proof for financial institutions or tax authorities.

The credit card statement is also similar to the Michigan Win Loss Statement. Both documents list transactions that reflect spending behavior. A credit card statement details purchases made on credit, while the Win Loss Statement details gambling activity associated with a player's card. Individuals often review these statements to manage their finances effectively. Just like the Win Loss Statement requires a signature for release, credit card statements may require acknowledgment of the account holder's responsibility for the charges incurred.

Additionally, the player loyalty program statement bears resemblance to the Win Loss Statement. This document provides a summary of rewards earned through participation in a loyalty program, often including points, bonuses, and other benefits. Similar to the Win Loss Statement, it requires the account holder's identification details and may need a signature for verification. Both documents help users understand their engagement with a casino or service provider, highlighting the value received from their participation.

The financial aid application form also shares commonalities with the Michigan Win Loss Statement. Both documents require detailed personal information and financial disclosures to assess eligibility for benefits. Just as the Win Loss Statement is used to substantiate gambling activity, financial aid applications often require proof of income and expenses. Each document plays a critical role in determining access to financial resources, whether for educational purposes or personal financial management.

Another comparable document is the insurance claim form. This form is used to report losses and seek reimbursement, similar to how the Win Loss Statement summarizes gambling losses for potential tax deductions. Both forms require specific information about the individual and the nature of the claim or request. The signature on each document serves to validate the information provided, ensuring that the request is legitimate and authorized.

The medical expense report is also akin to the Win Loss Statement. Individuals use this report to document healthcare costs for reimbursement or tax purposes, much like how the Win Loss Statement documents gambling expenses. Both require detailed information and often necessitate supporting documentation. These reports help individuals track their spending and can be used for financial planning or tax reporting.

Lastly, the business profit and loss statement shares similarities with the Michigan Win Loss Statement. Both documents summarize financial performance over a specific time frame, detailing income and expenses. While the Win Loss Statement focuses on gambling activities, the profit and loss statement encompasses broader business transactions. Each document serves as a tool for evaluating financial health, providing insights that can inform future decisions and strategies.

Dos and Don'ts

When filling out the Michigan Win Loss Statement form, it's important to follow certain guidelines to ensure your request is processed smoothly. Here’s a list of things you should and shouldn’t do:

  • Do provide accurate information. Double-check your name, Player’s Card Number, and other personal details.
  • Do include your signature. This is necessary for the form to be valid.
  • Do submit a copy of your Driver’s License or provide your Social Security Number for verification.
  • Do ensure that you are a Player’s Club Card member. Only members can request this statement.
  • Don’t forget to include the year(s) for which you are requesting the statement. This is crucial for processing.
  • Don’t leave out your contact information. Make sure your phone number and email address are included for any follow-up.

Following these steps will help you avoid delays and ensure that your request is handled efficiently. Remember, accurate and complete submissions are key!

Misconceptions

There are several misconceptions regarding the Michigan Win Loss Statement form that can lead to confusion. Understanding these misconceptions can help individuals navigate the process more effectively.

  • Only high rollers can request a Win Loss Statement. This is not true. Any Player’s Club Card member can request a Win Loss Statement, regardless of their gambling frequency or amount.
  • Couples must submit separate forms. In fact, a husband and wife can use one form to request their Win Loss Statement, simplifying the process for couples.
  • All gambling activity is tracked. The form clarifies that only play associated with a customer’s Player’s Club Card is tracked. Activities without the card are not included in the statement.
  • The Win Loss Statement is automatically generated. Individuals must submit a signed request to receive their statement; it is not automatically provided.
  • Requests can be made without identification. To process a request, individuals must include either a copy of their Driver’s License or their Social Security number for verification.
  • The Win Loss Statement reflects total gambling activity. The statement is based on player tracking information and may not accurately reflect all play, especially if the card was not used.
  • Statements are processed immediately. Statements will be processed after the first of the New Year unless a specific request is made for an earlier date.
  • Email requests are not accepted. Requests can be submitted via mail, email, or dropped off at the casino, providing multiple options for convenience.
  • There are no fees for requesting a Win Loss Statement. While there may not be a direct fee, individuals should be aware of potential costs associated with mailing or any required documentation.

Being aware of these misconceptions can enhance the experience of those seeking their Win Loss Statements. Clarity regarding the process ensures that individuals can receive their information without unnecessary delays or misunderstandings.

Key takeaways

Here are the key takeaways regarding the Michigan Win Loss Statement form:

  • Signed Request Required: Each customer must submit a signed request for the release of win/loss information.
  • Joint Requests Allowed: A husband and wife can use a single form to request their statements.
  • Player’s Club Membership: Only members of the Player’s Club can obtain win/loss statements.
  • Tracking Limitations: The casino does not track play that is not associated with the customer’s Player’s Card account.
  • Required Information: Complete the form with your name, Player’s Card number, Social Security number, date of birth, and mailing address.
  • Email Option: You can request to receive your statement via email by providing your email address on the form.
  • Release of Liability: By signing, you release the casino from any claims related to the provided information.
  • Indemnification Agreement: You agree to indemnify the casino against any losses or claims arising from releasing your information.
  • Accuracy Disclaimer: The statement may not accurately reflect all your play, as it only includes play linked to your Player’s Card.
  • Submission Guidelines: Complete forms must include a copy of your driver’s license or Social Security number for verification.
  • Processing Time: Statements will be processed after the first of the New Year unless a specific request is made.
  • Return Options: Submit your form via mail, email, or in person at the casino.

Ensure that all required information is accurately filled out to avoid delays in processing your request.