To receive a copy of your win/loss statement, please complete the form below (one for each person). The completed form will be sent to Treasure Island Resort & Casino when you click the submit button.

REQUEST FOR WIN/LOSS DOCUMENTATION for personal income tax filing. Slot Play only. Please complete the following information. All fields are MANDATORY. Failure to complete this form accurately may delay our response in completing your request. All win/loss information will be sent in detail. W2g will be sent based on availability.

Form Requested:

Primary Name (as shown on Island Passport Card):
For Income Tax Year(s):
 2016 2015 2014 2013 2012 2011
Island Passport Account:

Last four digits of SSN #:

Primary Address:
Zip Code:
Daytime Telephone:
Your Email (required)

Note: A separate signed request is required for each Passport Account

 I hereby request that the Prairie Island Indian Community, d/b/a Treasure Island Resort & Casino furnish me with the requested recorded information for my personal use. I hereby hold PIIC and TIR&C harmless of any errors that may be contained within the requested document I also understand that the figures contained within the requested document may not be indicative of my complete gaming win and or loss and is only that of which was recorded while utilizing my personal Island Passport Club card.

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