Duplicate W2G
W
REQUESST FORM
Your request will be completed within 14 business dayss from the date of receiiving the
complete
ed written request. The
e Duplicate W2G will be
e forwarded via mail or fax.
In additio
on to the co
ompletion off the below requested in
nformation, you are req
quired to pro
ovide
a photoccopy of your picture ID. If you are re
equesting th
his on behalff of someone
e else, a cop
py of
your pow
wer of attorn
ney will also
o be required
d.
Name:
N
Address:
Date of Birth:
Social Security No:
hone#:
Ph
Fax#:
Destin
nation Club Card#:
C
Year Reque
ested:
C
Check
One Option:
O
Fax ______
__
Signature:
Fax To:
662 35
57-2488
Mail To:
Resortts Tunica Ca
asino
1100 Casino
C
Strip Blvd.
P O Bo
ox 215
Tunica
a Resorts, MS
M 38664
Attn: Income Con
ntrol
Mail _______
Date:
Gambling
g Problem? Call 1-888-7
777-9696
1100 Casino
o Strip Bouleevard, Tunicaa Resorts, MSS 38664 www.reesortstunica.ccom 

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