Transcription of WINNER N.Y.S. Gaming Commission, Division of Lottery …
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WINNER N.Y.S. Gaming Commission, Division of Lottery …
US/Foreign PassportDriver License or Non-Driver IDDriver Learner PermitGovernment IDCertificate of NaturalizationCertificate of CitizenshipPermanent Resident Card (Green Card)Birth Certificate and a form of photo ID with nameUS Military IDNew York City IDNew York State Benefit ID CardMTA reduced Fare MetroCardCLAIM NUMBER _____ PROCESSED BY _____ DATE _____PRIZE AMOUNT _____ CHECK AMOUNT _____ CHECK NUMBER _____IDENTIFICATION TYPE _____ IDENTIFICATION NUMBER _____ EXPIRATION DATE _____CLAIMANT - COMPLETE THIS SECTION All information must be completed. PLEASE PRINT Are you a Bronx, Brooklyn, Manhattan, Yes No 13. Are you a Yonkers resident? Yes No 14. Do you own a store that sells Lottery ? Yes No 15. Are you employed by a Lottery retailer/sales agent? Yes No 16. Are you related to someone who owns or works at a Lottery retailer/sales agent?
MTA Reduced Fare MetroCard Social Security Card or Federal Taxpayer ID Certi˛cation must be included with these forms of ID. Title: claimform_rev_V2_10-2020 Created Date:
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