Transcription of CLAIM FORM - Ohio Lottery
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CLAIM FORM - Ohio Lottery
CLAIM form bank numberbank authorizationprize amountphoto idbank representativeohio Lottery representatvie DISTRIBUTION: WHITE- Lottery YELLOW-BANK BLUE-CLAIMANT OH!GRAPHICS 071409 CLAIMANT SECTION -- PLEASE PRINT CLEARLY!the information requested on a CLAIM form will be used to validate and process the CLAIM in accordance with ohio Lottery Commission rules and regulations and the ohio revised Code and to comply with tax reporting regulations. Failure to provide the information requested will delay the processing of your CLAIM . the information on this CLAIM may also constitute a public record pursuant to orC TICKETbet tiCket Control numberFOR Lottery USE ONLYINSTANT TICKETG ameserieslotseQuenCeCdvirn numberINSTRUCTIONS:Sign your name and print your name on the back of the ticket.
CLAIM FORM bank number bank authorization prize amount photo id bank representative ohio lottery representatvie DISTRIBUTION: WHITE-LOTTERY • YELLOW-BANK • BLUE-CLAIMANT OH!GRAPHICS 071409 CLAIMANT SECTION -- PLEASE PRINT CLEARLY!
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