Win/Loss Statements - Barona Resort & Casino

Player Name*

Email*

Phone Number*

D.O.B.

MM

DD

YYYY

Club Card Number*

Drivers License/ID Number*

Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zipcode Country

Last 4 SSN #*

Would you like your Win/Loss Tax Form Summary(W-2G and 1099-MISC Gross Win and Withholdings)?*

Yes
No

Delivery method*

Mail
Pick-up at Club Barona
Fax
E-mail

Would you like your Individual W-2G/1099-MISC/1042-S Tax Forms (cannot be emailed)?*

Yes
No

Delivery method (Email not available W-2G/1099-MISC)*

Mail
Pick-up at Club Barona
Fax

Select a Year*

2017
2018
2019
2020
2021

Fax

Annual Delivery Options

Would you like to receive your Win/Loss Tax Form Summary annually?

Yes
No

If the provided email is not on your account, do you approve Barona to send your forms to the mailing address on file?*

Yes
No

Checking the box below releases the Barona Band of Mission Indians, Barona Resort & Casino and its employees, officers or agents, from all liability for claims arising from, or related to, this request and the documents provided.*

I declare under the penalty of perjury that I am named as the winner on the IRS form W-2G/1099-MISC for the records that I am requesting. Neither the Barona Band of Mission Indians nor Barona Resort & Casino, its employees, officers or agents make any guarantee as to the accuracy of these reports.

Win Loss Form