Win/Loss - Cumberland Run

Win / Loss Form

To request a win/loss statement for tax purposes, please fill out the form below with your information. We will mail your statement to the address listed.

First Name*
Last Name*
Last 4 digits of Social Security #*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Email*
Birthdate*
Month
Day
Year
Form Requested*
Preferred Method*
Comments
Your Win/Loss Statement will include estimated Historical Horse Racing win/loss information from The Mint Gaming Hall at Cumberland. The tracking system used in providing this information is based on the use of your Players Club Card. Therefore, this statement will not reflect an accurate accounting record—it merely provides an estimate you can use to compare to your records. The IRS recommends that you keep your own records of your gaming activity. I do hereby certify that the information contained above is true and correct, and I authorize The Mint Gaming Hall at Cumberland to provide me a Win/Loss Statement of my Players Club account tracked gaming activity. In consideration of this, I agree to release and hold harmless The Mint Gaming Hall at Cumberland, and all of its directors, employees, officers, managers, affiliated persons, and representatives from any and all claims, causes of action, liabilities, costs, or damages arising from or relating to the information and its release as a result of this request. I further understand that the information requested is generated from a player’s tracking system based on my Players Club account history and is not intended to be, or take place of, my own records of my gaming activity. The Mint Gaming Hall at Cumberland makes no representation or warranty, express or implied, as to the accuracy of this information or its effectiveness as proof of winnings and losses.
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