TAX FORM REQUEST

To receive a copy of your W-2G or tax form, please complete the form below. Online requests may take up to two weeks to process. Multiple requests will delay response time. Failure to complete this form accurately may delay the completion of your request. Requested documents will be processed and sent to the email address listed on this form.

For same-day processing of your win/loss statement, visit MyIsland.

Primary Name (as shown on Island Passport Club card) *

First Name *

Last Name *

Island Passport Club Account Number

Last Four Digits of Social Security Number *

Phone Number

Date of Birth *

Email *

W-2G Year(s) Requested *

2025202420232022202120202019

W-2G Information *

Annual Summary Report

Re-send Tax Form(s)

None

W-2G Tax Form You Are Requesting: *

Request *

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 TIRC harmless of any errors that may be contained within the requested document.

Primary Account *

By checking this box, I verify that I am the primary account holder. I understand that falsifying my identity is a fraudulent act and is punishable by law.

Address

Street Address *

Address Line 2

City *

ZIP/Postal Code *

State/Province *

Leave this field blank

Submit