Win/Loss Request Form

Acknowledgment

I certify that the statements contained herein are true and correct, and hereby request that Rosie’s Gaming provide me with the information requested above. I understand that it is my own responsibility to maintain accurate records of play and that the win/loss statement is not an accounting record and is not appropriate for income tax reporting.

Please submit a copy of your ID with this request and mail to the address below.

Allow 2-4 Weeks for Processing Your Request.

Colonial Downs
ATTN: WIN/LOSS STATEMENT
10515 Colonial Downs Parkway
New Kent, VA 23124