Claim Form

Claimant Section

The information requested on a claim form will be used to validate and process the claim in accordance with the Ohio Lottery Commission Rules and Regulations and the Ohio Revised Code and that 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 149.43.

 

Instructions:

Sign your name and print your name on the back of the ticket. Complete items 1 through 12 on the Claim Form. Sign the form, and if the prize amount is $600 or greater, then also affirm that you either are, or are not, in default of a child/spousal support order. Be sure to include the original ticket and Pay to Bearer or File Claim Form receipt. Keep a copy of all documentation of this claim for your records.

Lottery prize amounts of $600 or greater are reported to the Internal Revenue Service. The Ohio Lottery issues a W-2G Form to the Winner. Winners sharing a prize must contact the nearest Ohio Lottery regional office.

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