In consideration of my receipt of this information, I agree to indemnify and hold harmless Ameristar Casinos, Inc., its subsidiaries and affiliates (including the Ameristar property indicated below), and their respective officers, directors, employees and agents from any and all claims, suits, causes of action, liabilities, costs, losses, damages, and expenses (including attorney’s fees and costs) which I, or my administrators, executors, agents, successors, heirs or assigns, or any third party, might have or incur as a result of, or in any way relating to, my receipt and/or use of the information. I understand that it is my own responsibility to maintain accurate records of play, and that the information I am requesting consists of estimates only and may not be appropriate for income tax reporting. I certify that the statements contained herein are true and correct, and I hereby request that the Ameristar property indicated below provide me with the information requested above.
W-2G Data: If you have won one or more jackpots exceeding $1,200 a report summarizing these winnings is available. Win-Loss Statement: A single page letter showing estimated play activity (wins or losses) based upon observable and/or carded gaming activity. PLEASE CHECK ONE OR BOTH OF THE FOLLOWING: SOCIAL SECURITY NUMBER PLAYERS CLUB CARD #
