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Recipient's  Address

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Lottery / Gaming Information Worksheet

Lump Sum Cash You Need Now

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Type of Payment being Received

 State Lottery    Gaming Award
Other Annuity/Award

Current Payment Amount

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Total Award You Won

   Date of 1st Payment   

Payment to be Paid Through (date)

   

State, casino, etc. where
this award was won and details

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(Why do you wish to sell?)

                                                             

                                                                    

 
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