I declare that I am the rightful owner of the ticket on this form, that I am 18 years and older, and that all information provided above are true and are given with my full consent.
I understand that, any person with intent to defraud, falsely makes, alters, forges or counterfiets a Lottery ticket is in violation of state law and could be liable for criminal penalties.
Failure to provide your personal information, contact details, or the accurate ticket information might prevent or delay the processing your prize claim.
Lottery prizes are not subject to Sate Income Tax.