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HHR Machines

Win/Loss Request Form

  • Date Format: MM slash DD slash YYYY
  • 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.

  • Date Format: MM slash DD slash YYYY
  • 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

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