SUBSCRIBED AND SWORN TO before me the NOTARY PUBLIC COUNTY STATE DO NOT WRITE IN THIS BOX - FOR HARD ROCK HOTEL CASINO SIOUX CITY USE ONLY VALID GOVERNMENT ISSUED IDENTIFICATION TYPE INSERT VALID GOVERNMENT ISSUED Notarized Valid Photo ID Verified Verifier s Signature and Date Please present this request to the Backstage Pass Rewards Club Desk at Hard Rock Hotel Casino Sioux City. Account Holder MUST present valid government issued photo ID acceptable to SCE Partners LLC in its sole and absolute discretion. City State Account Holder s Signature Holder may receive or request a Win/Loss Statement. Please mail the original request to Hard Rock Hotel Casino Sioux City Win/Loss Statement Request 111 3rd Street Sioux City IA 51101. If this request is not presented in person request must be notarized.
