Players BLUEGRASS DOWNS FAX 270-442-1993 PHONE 270-444-7117 PLEASE FILL OUT THIS FORM FOR THE HORSEMAN’S BOOKKEEPER NAME AND ADDRESS OF THE OWNER OR THE CORRESPONDING OFFICER OF THE STABLE WHO WILL BE RECEIVING THE PURSE CHECK. (This is the person or the entity that will receive a 1099 at the end of the year) NAME: _____________________________________________________________________ ADDRESS:¬¬¬¬¬¬¬¬¬¬¬ __________________________________________________________________ CITY:________________________________________STATE:__________ZIP:__________ PHONE:___________________ EMAIL ADDRESS:_____________________ SOCIAL SECURITY NUMBER:_______________________________ OR TAX ID NUMBER:_______________________________________ DO YOU HAVE A CURRENT KY RACING LICENSE: YES:________ NO:________ DO YOU HAVE A CURRENT USTA LICENSE: YES____ NO______ Certification of Taxpayer Identification Number Substitute Form W-9 I certify, under penalty of perjury, that (1) the Social Security number or other taxpayer identification number given above is correct and (2) I have not been notified by the Internal Revenue Service that I am subject to a Backup Withholding Order. Signature:_________________________________ Date:____________________ I agree to return to Players Bluegrass Downs any purse monies received should the horse earning the purse test positive. I further agree that reimbursement will be made within five(5) business days upon notification of the test results. Signature:___________________________________________________ Date:__________________ Please circle those that apply: OWNER TRAINER DRIVER PURSE CHECK: (circle) MAIL PICK-UP |
| Players BLUEGRASS DOWNS P.O. BOX 7907 PADUCAH, KY 42002-7907 PHONE (270)-444-7117 FAX (270) 442-1993 PLAYERS BLUEGRASS DOWNS AUTHORIZATION FOR ANOTHER PERSON TO PICK UP PURSE CHECK I give __________________________________________________________________ (name of person picking up check) permission to pick up my check. Signature:_____________________________________________________________ (name of person on purse check) Date:___________________________ |