8315 Park Road Batavia, NY 14020 (585) 343-3750-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the tax year for which you are requesting the Win/Loss statement in the designated field.
3. Fill in your Patron Number accurately to ensure proper identification.
4. Complete your Name, Street Address, City/State/Zip fields. Make sure all information is correct and clearly written.
5. Provide your Phone number in the specified format to facilitate communication.
6. If you are requesting copies of W2-G’s, include your Social Security Number; otherwise, leave this blank.
7. Enter your Date of Birth in the appropriate section to verify your identity.
8. Sign and date the form at the bottom to validate your request before submission.
9. Once completed, return the form as instructed or fax it to the provided number for processing.

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