Missouri Lottery Winner Claim Form at a glance
What it is: The Missouri Lottery Winner Claim Form is the Official Missouri Lottery Claim Form.
Who signs: Sign at Claimant's Signature and fill in the Date.
A filled-in Missouri Lottery Winner Claim Form example: a claimant collects a prize alone
How to fill out Missouri Lottery Winner Claim Form, box by box
Last Name, First Name, M.I. and Date of Birth
Fill in 1. Last Name, 2. First Name, 3. M.I. and 4. Date of Birth.
Mailing Address, Zip Code, SSN# / FIN#, Phone and U.S. Resident
Fill in 5. Mailing Address [Street, Route or PO Box#], 6. City, 7. State, 8. Zip Code, 9. SSN# / FIN#, 10. Phone and 11. U.S. Resident.
Amount of Prize, Number of people claiming prize and paid equally
Fill in 12. Amount of Prize [before taxes] and 13. Number of people claiming prize.
If more than one claimant: Is this prize to be paid equally? If not equally, enter dollar amount you are claiming.
Business that sells Missouri Lottery tickets
Check Yes or No for 16. Are you an employee of, related by blood or marriage to, or an owner/partial owner of a business that sells Missouri Lottery tickets?
If “Yes,” you must state the business name and address: Street, City.
Under penalty of perjury
Under penalty of perjury, you declare that the name, address and Social Security number, which you have furnished, correctly identifies you as the recipient of the prize claimed, that the ticket attached to this form has not been falsely made, altered, forged or counterfeited and all information set out on the form is correct.
More rules for Missouri Lottery Winner Claim Form
Complete items 1-17 on the form. Please use this form to claim INSTANT (Scratchers) or DRAW GAME prizes. You are hereby advised that items 1, 2, 3, 4, 5, 6, 7, 8, 11, and 12 are subject to being disclosed pursuant to a request under Chapter 610, Missouri Revised Statutes.
Please print your name, address and phone number on the back of your ticket; you must sign your ticket.
Any winning Missouri Lottery ticket worth $600 or less can be cashed at a licensed Lottery retailer selling that game, regardless of where the ticket was purchased and provided the cash is available (checked November 1, 2026).
In addition to the claim form, it is your responsibility to complete IRS Form W-9, Request for Taxpayer Identification Number and Certification for any taxable winnings over $600 (checked November 1, 2026).
Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.
Common questions about Missouri Lottery Winner Claim Form
Where do I file it?
Retain a photocopy of the front and back of your winning ticket and of this completed form for your personal records. Staple the ticket to the top right corner of this form. Mail this form and the winning ticket to: MISSOURI LOTTERY, PO BOX 7777, JEFFERSON CITY, MO 65102-7777, or hand deliver your ticket and completed claim form to any Missouri Lottery office.
Sources
[1] Missouri Lottery Winner Claim Form (Rev. October 2018), Missouri Lottery (the Official source link on this page).