LINDA’S SPEEDWAY
2010 1099 TAX FORM

DATE__________________ DIVISION_____________ CAR #______

THIS FORM MUST BE FILLED OUT COMPLETELY IN ORDER TO RECEIVE ANY PAYOFF MONEY

IN THE EVENT DRIVER CHANGES CAR NUMBER AND/OR CAR OWNER ANOTHER FORM MUST BE FILLED OUT
**PLEASE PRINT CLEARLY**

DRIVERS NAME____________________________________________

ADDRESS__________________________________________________

CITY OR TOWN_____________________________STATE_________

ZIP___________________ HOME PHONE (____)_________________

DRIVER SS# OR FED ID #___________________________________

***********************************************************

CAR OWNERS NAME_______________________________________

ADDRESS__________________________________________________

CITY OR TOWN_____________________________STATE__________

ZIP___________________PHONE(____)__________________________

CAR OWNER SS # OR FED ID #________________________________

OWNER SIGNATURE________________________________________

NOTE: FEDERAL TAX STATEMENT NP. 1099 WILL BE ASSIGNED & MAILED TO CAR OWNER

PLEASE RETURN COMPLETEDFORM TO LISA CHORPENNING AT PIT OFFICE