California Scratchers PDF Details

The California Scratchers, also known as the Golden State Lottery, was established in 1985 to provide an additional source of revenue for the state budget. The lottery is a popular pastime for many Californians who are looking for ways to have fun and earn some extra money. Since its inception, more than $15 billion has been paid out to winners. The lottery offers instant games where players scratch off numbers on cards or pull tabs from paper tickets to reveal prize amounts which range from $1 up to $10 million depending on the game being played.

You will find information regarding the type of form you would like to submit in the table. It can show you the time it will require to fill out california scratchers, exactly what fields you need to fill in and several further specific details.

QuestionAnswer
Form NameCalifornia Scratchers
Form Length3 pages
Fillable?Yes
Fillable fields54
Avg. time to fill out11 min 37 sec
Other namescalifornia lottery claim form pdf, california lottery winner claim form, lottery form get, calottery scratchers

Form Preview Example

Cash all prizes of $599 or less at participating Lottery Retailers

CLAIMANT INFORMATION PLEASE READ ALL INFORMATION AND INSTRUCTIONS BEFORE COMPLETING CLAIM FORM

LAST NAME

FIRST NAME

ADDRESS 1

ADDRESS 2

CITY

COUNTRY

 

 

 

 

 

 

DATE OF BIRTH

 

-

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MONTH

 

DAY

 

YEAR

MI

 

 

SUFFIX

 

 

 

 

SSN/TIN

 

-

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE

ZIP CODE

-

E-MAIL

PHONE

 

-

 

-

 

 

 

 

 

 

AREA CODE

 

 

I am a Lottery Retailer

I am employed by a Lottery Retailer I am related to a Lottery Retailer

Check one (for tax purposes only):

I do not have a Social Security Number

I am not a U.S. Citizen, and I am not a Resident Alien

TICKET INFORMATION

Attach the original ticket to this form with your legal name, signature and address showing. Enter the

information below (Scratchers 13-18 digit ticket number is located on back of ticket; Draw Game 18 digit ticket number is located on front of ticket). Attach another claim form for more than one ticket.

Ticket Number:

Prize Claim: $

I declare, under penalty of perjury under the laws of the State of California, including but not limited to California Penal Code §§ 118 and 72, that I am the rightful owner of the ticket on this form, that I am 18 years of age or older, and that all information provided is true and correct. I understand that any person who, with intent to defraud, falsely makes, alters, forges or counterfeits a Lottery ticket is in violation of state law and could be liable for criminal penalties.

Claimant Signature

 

Date

(Only one signature, and it must match signature on ticket)

FOR DISTRICT OFFICE USE ONLY

PLAYER I.D. CODE

DIST. OFFICE CODE

 

DATE RECEIVED

 

 

 

 

 

DRAW DATE

 

INITIALS

 

 

 

 

 

 

 

 

 

 

 

 

FOR HEADQUARTER OFFICE USE ONLY

POST MARK DATE

CODE(S)

REASON

RELEASED

CRN

CSL 1242 (R7/19)

Page 1 of 3

PRIZE PAYMENT INFORMATION

Failure to provide your original signed ticket with date of birth, legal name, complete address (including apartment or space number, city, state, zip code), email and phone number may delay or prevent the California State Lottery (Lottery) from processing your prize claim. Claims submitted to Lottery Headquarters for processing are paid by check and mailed from the California State Controller's Office. Processing time, once claim is received and verified, is approximately 8 weeks. If you have questions, contact the Lottery at 1-800- LOTTERY (568-8379), Monday through Friday.

Lottery prizes are not subject to California state income tax. The Lottery is required by federal tax law to withhold federal taxes of 24% for U.S. citizens and resident aliens. Non-US citizens will have 30% withheld from all prizes.

Tickets, transactions, purchases, claims and prize payments are subject to federal and state law and California Lottery regulations, policies and procedures. Copies of regulations are available at Lottery District Offices and on our website at www.calottery.com. Tickets failing validation are void.

INSTRUCTIONS

1.Print your legal name, street address, city, state, and zip code on the back of the ticket.

2.Sign your name on the back of the original ticket.

3.Complete the Claimant Information and Ticket Information sections on the first page of thisform.

4.Sign the first page of this form with ink. (ONLY ONE SIGNATURE IS PERMITTED)

5.Staple your original ticket to the front of this form.

KEEP A COPY OF THIS FORM AND A COPY OF THE FRONT AND BACK OF THE TICKET.

Deliver the completed claim form with original ticket to any Lottery District Office. Location and directions can be found at www.calottery.com.

OR, MAIL THIS CLAIM FORM, AT YOUR OWN RISK, WITH THE ORIGINAL TICKET STAPLED ON THE FRONT, TO: California Lottery, 730 North 10th Street, Sacramento, CA 95811-0336

Call 1-800-LOTTERY(568-8379), or visit any Lottery District Office to request a Multiple Ownership Claim form for group players (less than 100) sharing prizes of $1,000,000, or more.

PRIVACY NOTICE

The Information Practices Act of 1977 (Cal. Civ. Code §§1798-1798.78, the Federal Privacy Act (Public Law 93-579), 5 U.S.C. §552a, and Cal. Gov. Code §§11015.5 and 11019.9, require that this notice be provided when collecting personal information from individuals.

The Claimant Information requested on this form will be used to validate and process your claim in accordance with the California State Lottery Act of 1984 (Gov. Code §8880 et seq.). The Lottery requests a player's social security or

tax identification number (SSN/TIN) for tax withholding and reporting purposes, pursuant to Internal Revenue Code

§§6011, 6041, 6109, 3402, and the regulations enacted thereunder.

The Claimant Information you provide may be disclosed to various state and federal government agencies, including but not limited to: the State Controller's Office, Franchise Tax Board, Health and Welfare Agency, and the Internal Revenue Service. It will not be disclosed to members of the public.

You have the right to access your personal information maintained by the Lottery by contacting the California Lottery, 700 North 10th Street, Sacramento, CA 95811-0336 - Attention: Privacy Coordinator, Information Security Office - Security and Law Enforcement Division. The Privacy Coordinator can also be reached at 916-822-8800 or privacy@calottery.com.

Purpose and Relevancy of Information Collected: Information is collected to validate and process a claim and for purposes of sales, marketing, research, security investigation, legal review, surveys, and strategic planning as related to the operations of the Lottery. By submitting this claim, you consent and agree to such use, and waive any and all legal claims, known or unknown, related to the specified uses set forth herein. The California Lottery is subject to public disclosure laws that allow access to certain governmental records. Your full name, the name and location of the retailer who sold you the winning ticket, the date you won, and the amount of your winnings, including your gross and net installment payments, are matters of public record and are subject to disclosure. The Lottery will not disclose any other personal or identifying information without your permission unless legally required to do so. No information will be collected or accepted from known minors. You may be asked to participate in a press conference.

CSL 1242 (R7/19)

Page 2 of 3

VOLUNTARY DEMOGRAPHIC INFORMATION

By volunteering to answer the following questions, you will help the Lottery know more about its players. The voluntary information that you provide regarding your ethnicity, household income, gender, and household composition will be used only by the Lottery to conduct internal demographic analyses (which may be completed by agents and contractors).

Which of the following do you consider yourself to be?

(Check all that apply)

African American

Asian

Hispanic

White

Other (Specify)

Annual Household Income

Under $30,000

$30,000 TO $49,999 $50,000 TO $99,999

$100,000 TO $149,999

$150,000 or more

Number of People in Household

(including yourself):

Gender

Female

Male

Nonbinary

CSL 1242 (R7/19)

Page 3 of 3

How to Edit California Scratchers Online for Free

We were building this PDF editor with the prospect of making it as easy to use as possible. For this reason the process of filling out the ca lottery claim form will be smooth as you go through these actions:

Step 1: At first, pick the orange "Get form now" button.

Step 2: You're now equipped to alter ca lottery claim form. You've got many options with our multifunctional toolbar - you'll be able to add, remove, or modify the text, highlight its particular elements, as well as carry out other commands.

Create the ca lottery claim form PDF and type in the material for every segment:

ca lottery claim form pdf spaces to complete

Please type in the required data in the Ticket Number:, Prize Claim:, I declare, Claimant Signature, Date, (Only one signature, FOR DISTRICT OFFICE USE ONLY, PLAYER I, FOR HEADQUARTER OFFICE USE ONLY, POST MARK DATE, DRAW DATE, INITIALS, CODE, S REASON, and RELEASED space.

ca lottery claim form pdf Ticket Number:, Prize Claim:, I declare, Claimant Signature, Date, (Only one signature, FOR DISTRICT OFFICE USE ONLY, PLAYER I, FOR HEADQUARTER OFFICE USE ONLY, POST MARK DATE, DRAW DATE, INITIALS, CODE(S), REASON, and RELEASED blanks to complete

The system will require for further information with a purpose to instantly complete the field White, Other (Specify), and Number of People in Household.

stage 3 to finishing ca lottery claim form pdf

Step 3: After you select the Done button, your finalized form may be exported to any of your gadgets or to email indicated by you.

Step 4: To prevent any type of challenges in the long run, try to prepare around two or three copies of the file.

Watch California Scratchers Video Instruction

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .