What type of prize winning was it? 

State Lottery       IGT Casino Winnings

Other, please specify 

Have you sold any payments before?  Yes  No  

If Yes, to what company? 

What was the Win Date? 

Were you the ONLY winner?  Yes  No  

If No, how many other winners? 

What percent did you win? 

What was the GROSS amount won? 

What is the gross ANNUAL PAYMENT amount? 

What is the NET annual payment? 

In what STATE was the prize won? 

         

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