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Win Loss Request Form

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Summarizing these winnings is available. Request Agreement I certify that the statements contained herein are true and correct, and I hereby request Indian Head Casino provide me with the information requested above. 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. In consideration of my receipt of this information, I agree to indemnify and...

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