Prize Claim Form
Prize Claim Form
lottery claim form
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Note: All late claim lottery and gaming credit applications must be submitted via the online application portal by the October 1 deadline
Attach a separate claim form for each ticket submission Ticket Number: Prize Claim: $ I declare, under penalty of perjury under the laws of the State of
lottery sambad 1 8 23 Lottery tickets are bearer instruments Once a ticket is signed the • BEFORE FILING THIS CLAIM FORM PLEASE READ INSTRUCTIONS ON BACK OF YOUR
lottery tax calculator illinois IMPORTANT INFORMATION · A signed winning ticket · A completed claim form for prizes of $600 and more · Proof of ID such as State-Issued