Michigan Lottery Form ≡ Fill Out Printable PDF Forms Online

Michigan Lottery Form PDF Details

For Michigan lottery form information, the lottery commission provides an online application. The application is simple to fill out and submit. In addition to providing your personal information, you must also declare how much money you would like to spend on tickets each week. If you win a prize greater than $600, the state will withhold 25% of your winnings for federal taxes. Note that these taxes are in addition to the 6% Michigan state tax withheld from all prizes won in the state. Finally, if you'd like to remain anonymous after winning a prize, the state allows you to do so at no cost.

Here, you may find quite a few details about michigan lottery form PDF. Prior to complete the form, it is worth checking more about it.

Question	Answer
Form Name	Michigan Lottery Form
Form Length	26 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	6 min 30 sec
Other names	michigan lottery form 5754, michigan lotery forms, mi lottery application, michigan lottery license application

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RETAILER

APPLICATION

Rev. October 2019

MICHIGAN LOTTERY

RETAILER SERVICES

101 E. HILLSDALE, BOX 30023 LANSING, MICHIGAN 48909

retailers.michiganlottery.com

MICHIGAN LOTTERY RETAILER - APPLICANT REQUIREMENTS -

The requirements listed below pertain to Retailers interested in selling Michigan Bureau of State Lottery (Lottery) products. Failure to meet any of these requirements, the terms and conditions of the contract or any other provision of the Lottery Act and Rules may result in disciplinary action up to and including license revocation depending on the nature and severity of the violation.

1.The Lottery advises all applicants for licenses and/or changes of ownership not to invest any money or commit themselves by any binding agreements in the expectation of being issued a license or approval of a change of ownership until ofﬁcially notiﬁed by the Lottery that their application has been approved.

2.Most applicants with an acceptable credit history and no criminal record that would adversely affect the integrity of the Lottery may be licensed. Lottery may require a bond from a Retailer as a condition

of licensure. ANY CRIMINAL RECORD MUST BE DISCLOSED ON PERSONAL DATA SHEETS.

3.The items listed in the applicant checklist are required before the Lottery will license the location.

4.A nonrefundable application fee of $150 is due at time of application. This fee may be remitted by check payable to the State of Michigan or paid on-line at https://www.thepayplace.com/mi/lottery/retailerserv

5.Retailers are required to maintain a separate account in a ﬁnancial institution that is a member

of The National Automated Clearing House Association. The Lottery must be authorized to initiate electronic funds transfers (EFT) to or from the Retailer’s designated account for the net weekly settlements due from the sale of instant and/or on-line game tickets. The Retailer shall ensure that “good” funds shall be available in the designated account to cover said transfers on the day of week speciﬁed by the Lottery.

“Good” funds are deﬁned as unrestricted funds credited to a Retailer’s account that a ﬁnancial institution will release for payment of an EFT. Unrestricted funds do not include checks placed on hold until they have cleared the maker’s account or deposited checks that the maker’s ﬁnancial institution has returned unpaid. Any cash alternative settlement methods (such as line of credit, overdraft protection, a pre-approved loan, or any other arrangements) agreed upon with your bank are the Retailer’s responsibility. If a settlement is not honored by your bank, regardless of the reason, the Lottery will consider it a delinquency.

Applicants should submit a completed Electronic Funds Transfer (EFT) Authorization Form with the application. If this EFT account will not be established until closing of the sale, a void check or a letter, on bank letterhead, with the bank’s routing number and your checking account number may

be submitted at that time. Lottery products will not be made available to the Retailer until this information is provided.

6.Annual license renewal fee is $200. This fee will be waived for those Retailers who are not on probation for violation of the Lottery Act or its Rules at the time of renewal.

7.It is recommended the Retailer provide (prior to the installation of Lottery equipment) a dedicated circuit with 115 volts, 20 Amp. 60 HZ service with an isolated ground that remains on 24 hours per day. The dedicated circuit must have a 4 outlet box that will accommodate 3 prong, “U” grounded type plugs. The Lottery reserves the right to require a Retailer to obtain certiﬁcation of a dedicated electrical circuit from a qualiﬁed electrician. All installation and ongoing costs for this service will be the responsibility of the Retailer. The outlet shall be located within ﬁve feet of the terminal. The Retailer shall provide sufﬁcient space for the operation of the equipment.

-OVER -

Authority: Act 239, 1972 as amended.

BSL-S-685A(5/19)

8.BUSINESS TYPE - to determine your business type use these deﬁnitions when completing the application. A Personal Data Sheet and signature is required before the application will be processed.

a.PROPRIETORSHIP - a business enterprise doing business under an assumed name, that is owned by one person (not registered with the Michigan Department of Labor & Economic Growth). A Proprietorship may use the owner’s Social Security number as a tax identiﬁcation number or s/he may have a registered Federal Employer Identiﬁcation Number (FEIN). The owner must complete and sign the contract and submit a Personal Data Sheet.

b.PARTNERSHIP - a business enterprise doing business under an assumed name that is NOT registered as a Partnership with the Michigan Department of Labor & Economic Growth. Each Partner must sign the contract and Personal Data Sheets must be provided for all partners.

c.LIMITED PARTNERSHIP - a business enterprise, doing business under an assumed name, that IS registered as a Partnership with the Michigan Department of Labor & Economic Growth. A General Partner must sign the contract and Personal Data Sheets must be provided for all general partners.

d.LIMITED LIABILITY COMPANY - a business enterprise, doing business under an assumed name, that is registered as an unincorporated association with the Michigan Department of Labor & Economic Growth. Members are required to sign the contract and submit Personal Data Sheets. (Members are deﬁned as persons having ownership interest in a limited liability company.)

e.CORPORATION - a business enterprise organized as a corporate entity, doing business under an assumed name, that is registered with the Michigan Department of Labor & Economic Growth.

“Closely Held Corporation” means a corporation where a majority (more than 50 percent) of the outstanding voting stock is owned by ten or fewer persons. Any person authorized and empowered to execute contracts and bind the corporation to its terms and obligations may sign the contract. A Personal Data Sheet is required for each owner/shareholder, except that any individual owning less than 10 percent may be listed on a separate sheet of paper and is required only to provide name, Social Security number and percent of ownership.

“Non-Closely Held Corporation” means a corporation where a majority (more than 50 percent) of the outstanding voting stock is owned by more than ten persons. The Principal Operating Ofﬁcer(s) is/are required to sign the application and submit Personal Data Sheet(s). (A Principal Operating Ofﬁcer is deﬁned as a person designated to conduct business in the State of Michigan on behalf of the corporation being licensed.)

f.To properly comply with the reporting requirements for the Internal Revenue Service, the Lottery must change the Retailer number assigned to you when you change your business structure. The Lottery deﬁnes a change in business structure as anytime your Taxpayer Identiﬁcation Number, Corporate Number or business type (sole proprietor, partnership or corporation) changes.

When your Retailer number is changed, we must ﬁnancially close out the old Retailer number. This will result in all activated books having to be settled and paid for, regardless of the length of

time they have been activated or the percentage of validations that have occurred within each book. Once a book has been activated we are unable to reassign the book, which is why payment is required.

You will then be assigned a new Retailer number and all conﬁrmed books will be reassigned to this new number.

9.Please note that the accompanying Retailer license application requires that you indicate if your business is in compliance with the Americans with Disabilities Act (ADA). If you have any questions about compliance, please contact the State ADA Coordinator, at 517-373-3125.

If you have any questions, call RETAILER SERVICES (517) 335-5619.

Send completed documents to: Michigan Lottery

Attn: Retailer Services

P.O. Box 30023

Lansing, MI 48909

MICHIGAN LOTTERY

RETAILER SERVICES

101 E. HILLSDALE, BOX 30023 LANSING, MICHIGAN 48909

retailers.michiganlottery.com

MICHIGAN LOTTERY RETAILER - GENERAL REQUIREMENTS -

1.A person must be 18 years of age or older to buy or sell Lottery tickets.

2.Retailers must display their Lottery license or a copy of their Lottery license in a conspicuous place.

3.Retailers may sell tickets only on the premises indicated on the license. Only instant tickets issued to a speciﬁc location can be sold at that location. Retailers may not exchange books of instant tickets with other Retailers or stores.

4.All Retailers are expected to redeem winning tickets with a value up to and including $600. Winning tickets must be validated through the validation system(s) for the Retailer to receive credit.

5.Write your Retailer number on the back of all winning tickets that you redeem and deface the validation number. Destroy redeemed tickets after balancing.

6.Retailers are expected to make full use of all promotional material provided by the Lottery and to prominently post winning numbers/symbols and jackpot amounts as soon as possible.

7.Retailers are expected to participate in Lottery signage programs and to display approved sign(s) provided by the Lottery.

8.Traditional Retailers are required to offer for sale instant tickets.

9.Lottery tickets cannot be sold for more than their established price. They can be sold for less than their established price as a special promotion if the Retailer desires. Retailers who sell tickets to other Retailers for resale are in violation of the Lottery Act & Rules.

10.Retailers cannot offer to give any money or other thing of value to the holder of a Lottery ticket

or share for winning the Lottery, other than the prize if payment of the prize by the Retailer is authorized by the Commissioner. Retailers who offer bonuses to Lottery winning tickets holders are in violation of the Lottery Act & Rules.

11.Retailers cannot purchase a winning ticket or tickets from an original purchaser or from a subsequent purchaser.

12.Retailers are prohibited from participating as a Retailer for other Lotteries.

13.The sale of a valid Lottery ticket is ﬁnal and a Retailer shall not accept ticket returns.

14.Lottery may prohibit a person authorized by the Retailer from participating in a Lottery activity i.e. selling tickets or redeeming tickets.

15.A Retailer, upon issuance of a license, will receive 6% commission on each ticket sold at the terminal, 5% sales commission on all cashless transactions on cashless ﬁtted equipment and a 2% commission on any prize paid. Retailers may also receive bonus commissions as stated in Lottery directives. For more information on bonus commissions visit the Lottery website.

16.Retailers are expected to maintain current and accurate records of all operations in conjunction with sales in conformity with Rules, instructions, and directives of the Lottery. The Retailer is required to make the records available to Lottery representatives upon request.

-OVER -

Authority: Act 239, 1972 as amended.

BSL-S-685B(5/19)

17.The Retailer shall exercise due diligence in the operation of any installed equipment and shall immediately call 1-800-592-4040 and press option #1 when his or her equipment malfunctions. The Retailer shall refrain from attempting to perform any mechanical or electrical maintenance or repairs to the equipment except as instructed by Lottery or its authorized representative. If terminal malfunction is a result of Retailer noncompliance with Lottery guidelines or speciﬁcations, the Retailer may be responsible for repair and/or service charges. The Retailer shall replace ribbons, paper stock, and clear paper jams as required.

18.A Retailer does not have a property interest in the license granted by the Lottery or in the online Lottery terminal.

19.The Retailer will act in a ﬁduciary capacity with respect to all tickets accepted from Lottery or its authorized distributors until payment has been made.

20.Retailers are responsible for all tickets consigned to them. If tickets are stolen, then the Retailer shall report the theft to the Lottery and to local or state police authorities. The Retailer shall pay for the stolen tickets on the settlement date. The Retailer shall subsequently ﬁle a statement swearing to or afﬁrming, under the penalty of perjury, the facts of the case. The Retailer shall furnish to Lottery a copy of the police report covering the theft. Following an investigation by Lottery and police authorities, Lottery may issue a refund to the Retailer. Refunds may only be issued if losses to Lottery have been mitigated by Retailer’s actions in reporting the tickets stolen and the Retailer’s appropriate accounting of tickets stolen.

21.The Retailer shall be responsible for the physical security of the Lottery equipment. Damage to the equipment/satellite communication lines attributable to the Retailer’s negligence will result in an assessment to the Retailer for the cost of equipment repair or replacement.

22.Retailers agree to hold Lottery and the State of Michigan harmless from any liability arising in connection with the sales or redemption of Lottery products.

23.If you plan to sell your business and the buyer wants to continue Lottery sales, a change of ownership must be approved by the Lottery. The buyer should submit an application approximately 45 days prior to closing. Contact Retailer Services for details (517) 335-5619.

MICHIGAN LOTTERY

RETAILER SERVICES

101 E. HILLSDALE, BOX 30023 LANSING, MICHIGAN 48909

retailers.michiganlottery.com

MICHIGAN LOTTERY RETAILER

- WEEKLY SETTLEMENT REQUIREMENTS -

1.Retailers must not be delinquent in settling accounts with the Lottery.

2.Retailers are required to maintain a separate bank account for Lottery use only in a ﬁnancial institution that is a member of The National Automated Clearing House Association. The Lottery must be authorized to initiate electronic funds transfers (EFT) to or from the account.

3.Cash only must be deposited in this account, do not include checks in your deposit.

4.The sales week is Tuesday through Monday. Your invoice is available Tuesday of each week. Bank deposits must be made by 2:00 p.m. on Tuesday to assure available funds for EFT withdrawal.

5.A Retailer’s selling privileges may be suspended upon determination that the Retailer is delinquent for any settlement. Retailers are considered delinquent when sufﬁcient good, available funds are

not available in the ﬁnancial institution account at the time the Lottery attempts to electronically withdraw the Retailer’s settlement.

6.Retailers are expected to promptly “make good” a delinquency by remitting a cashier’s or certiﬁed check to the Lottery for the full amount of the delinquency plus any delinquency fee. A fee may be assessed for each delinquency in accordance with the fee schedule currently in effect.

7.A Retailer who fails to “make good” a delinquency shall be subject to license revocation. A retailer may also be subject to collection proceedings for failure to “make good” on a deliquency. Collection proceedings may be initiated by the Lottery or by a designated third-party.

8.A Retailer who exceeds the established number of delinquencies within six consecutive months shall be subject to license revocation or be required to post a cash bond to continue as a licensed Retailer.

Authority: Act 239, 1972 as amended.

BSL-S-685D(5/19)

MICHIGAN LOTTERY

RETAILER SERVICES

101 E. HILLSDALE, BOX 30023 LANSING, MICHIGAN 48909

retailers.michiganlottery.com

MICHIGAN LOTTERY RETAILER

- PERFORMANCE REQUIREMENTS -

1.The Retailer shall immediately notify Retailer Services of any lapse in on-line terminal operation that will exceed 48 hours in duration.

2.The Retailer’s license may be revoked if the Retailer has an unapproved lapse in operation that exceeds 30 calendar days.

3.Under Lottery Rules, the Retailer must pay the fees established by Lottery. These fees include the following:

a.Application Processing Fee - $150 A nonrefundable application fee is due at the time of application.

b.Investigation Fee - $700 This fee may be assessed to the Retailer when an investigation is conducted resulting in disciplinary action.

c.Satellite Communication Equipment Installation Fee - $550 This fee is for the installation of communication service for an on-line Lottery terminal.

d.Delinquency Fee - $200 This fee may be assessed by the Lottery each time a Retailer is delinquent.

e.Annual License Renewal Fee - $200 This fee will be waived for those Retailers who are not on probation for violation of the Lottery Act or its Rules at the time of renewal.

4.Retailers will be given written notice when fees are changed by Lottery.

5.All Retailers may be subject to a terminal minimum sales performance evaluation every quarter. Failure to meet the minimum sales performance may result in license revocation. The minimum

sales performance amount is set by the Lottery and is subject to change, but will not exceed a $4,000.00 weekly average.

6.Failure to meet the performance requirements or the contract terms and conditions may result in disciplinary action depending on the nature and severity of the violation. When the severity of a violation warrants equipment removal and/or license revocation, the Retailer may request a conference with the Commissioner or the Commissioner’s designee. At this informal conference, the alleged violation will be reviewed with the Retailer. The Retailer will have the opportunity to refute the alleged violation or to explain the reasons for the violation. The Retailer will be notiﬁed in writing of the Commissioner’s decision. The Commissioner’s decision is ﬁnal.

7.It is each owner/shareholder’s responsibility to report to the Lottery any changes in his or her personal or business situation that would adversely aﬀect Lottery’s integrity and/or its operations. This includes but is not limited to: any change of ownership, changes in a home address, phone number, etc; misdemeanor or felony convictions; liquor, food stamp, or tobacco violations; tax defaults or liens; personal or business bankruptcies; or any pending lawsuits against an owner/shareholder

or the business.

8. Each owner/shareholder authorizes the release of all information regarding his or her personal/business credit and criminal history to the Lottery. Each owner/shareholder understands it is his or her responsibility to report any changes in a personal or business situation. Each owner/shareholder accepts that any violation of the Lottery Act, Rules, contract, directives, instructions, or communications (including this communication) may be cause for revocation of any Lottery license.

To report any changes, contact Lottery at: Michigan Lottery, Retailer Services, P.O. Box 30023,

Lansing, MI 48909; or by fax at (517) 335-5757; or by emailing MSL-Licensing@michigan.gov or by calling (517) 335-5619.

Authority: Act 239, 1972 as amended.

BSL-S-685C(12/19)

MICHIGAN LOTTERY

RETAILER SERVICES

101 E. HILLSDALE, BOX 30023 LANSING, MICHIGAN 48909

retailers.michiganlottery.com

MICHIGAN LOTTERY RETAILER

- OPERATIONAL RULES -

PULL TAB GAMES

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The following business types are eligible to sell Pull-Tabs: bar/restaurant, bowling center, golf, social club, adult entertainment, and recreation.

Retailers are prohibited from selling Pull Tab tickets for a price other than the price printed on the ticket.

Pull Tab tickets may be sold from vending machines speciﬁcally designed to dispense Pull Tab tickets, by waitstaff, from “ﬁshbowl” type containers, or through special promotional packaging provided by the Lottery. The cost to purchase or lease the vending machine(s) is the responsibility of the Retailer unless the game is sold in special promotional packaging provided by the Lottery.

Retailers receive a 6% commission on each Pull Tab ticket sold and a 2% commission on any prize paid, unless otherwise stated in the Lottery contract.

Retailers are prohibited from selling Pull Tab tickets to a visibly intoxicated person.

Retailers may not end sales of a game until all tickets from the deal are sold or unless a game has expired.

Retailers may redeem winning tickets of $600 or less. Prizes of $601 and above must be claimed at a Lottery claim center or Lottery ofﬁce.

Retailers must pay the full amount of all prizes redeemed from valid winning Pull Tab tickets.

A winning prize must be claimed prior to the expiration date listed on the Pull Tab ticket.

Retailers may not manipulate the Pull Tab game in order to prevent prizes from being awarded.

Retailer employees and owners may purchase, play and redeem Pull Tab tickets.

Authority: Act 239, 1972 as amended.

BSL-S-1893(5/19)

MICHIGAN LOTTERY

RETAILER SERVICES

101 E. HILLSDALE, BOX 30023 LANSING, MICHIGAN 48909 retailers.michiganlottery.com

NONPROFIT LICENSEES ONLY

- REQUIREMENTS -

The requirements listed below pertain to the licensing of nonproﬁt organizations.

PRINCIPAL OFFICERS

The Retailer Contract/Application must be signed by the three principal ofﬁcers (i.e. president, vice president, treasurer, secretary) of the organization.

Each of the principal ofﬁcers must complete and sign a Personal Data Sheet authorizing the Lottery to perform a personal criminal and credit check.

The Lottery reserves the right to deny or revoke a license based on the criminal and/or credit history of any principal ofﬁcer.

Lottery references to owners/ownership means any and all of the principal ofﬁcers and/or Lottery chairpersons.

Principal ofﬁcers must be at least 18 years old.

Any change in principal ofﬁcers must be reported to the Lottery by completing a new Retailer Contract/ Application and Personal Data Sheet.

LOTTERY CHAIRPERSON

Each location must designate a Lottery chairperson who will be the Lottery contact and responsible for all Lottery activities. This includes making the Lottery deposits on Tuesday before 2:00 p.m., stocking supplies, and other necessary activities.

The Lottery chairperson, if different from the principal ofﬁcers, must sign the Retailer Contract/Application. He/she must also complete and sign a Personal Data Sheet authorizing the Lottery to perform a personal criminal and credit check.

The Lottery reserves the right to deny or revoke a license based on the criminal and/or credit history of the Lottery chairperson.

The designated Lottery chairperson must be indicated on the Retailer Contract/Application.

The Lottery chairperson must be at least 18 years old.

Any change in the Lottery chairperson must be reported to the Lottery by completing a new Retailer Contract/Application and Personal Data Sheet.

OWNERSHIP OF BUILDING

A copy of the lease, deed, rental agreement or other proof must be provided to show the organization’s legal right to occupy the building/premises.

LOTTERY ACT & RULES

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The principal ofﬁcers and Lottery chairperson, by signing the Retailer Contract/Application and Personal Data Sheet, agree to comply with the Lottery Act and Rules, or the requirements, instructions and directives of the Commissioner or Bureau.

The organization must comply with any Michigan Liquor Control Commission Rules or statutes. Speciﬁcally, organizations must adhere to prohibitions that no alcohol is sold to anyone who is not a bona ﬁde member or guest of the club (as deﬁned by statute).

Authority: Act 239, 1972 as amended.

BSL-S-2044(5/19)

MICHIGAN LOTTERY

RETAILER SERVICES

101 E. HILLSDALE, BOX 30023 LANSING, MICHIGAN 48909 Retailers.michiganlottery.com

MICHIGAN LOTTERY RETAILER

- PROBLEM GAMBLING INFORMATION -

- RETAIN THIS PAGE FOR FUTURE REFERENCE -

The Michigan Lottery is dedicated to ensuring our players are provided with a fun and safe form of entertainment. As part of this effort, $1 million is provided each year to help fund statewide education and treatment programs for problem gaming, as well as the Michigan Problem Gambling Helpline.

Problem gambling may affect anyone, regardless of age, race, gender or financial status. Once it is detected, problem gambling may be treated successfully. The first step is determining if you have a problem or are headed toward a problem.

WARNING SIGNS OF PROBLEM GAMBLING
• Missing work or sacrificing time with your	• Selling or pawning property to get money
family to gamble	for gambling
• Gambling is causing problems with your	• Spending money on gambling that should
family	have gone to pay your bills
• Lying about the time spent gambling or the	• Gambling more to recover your losses
money you’ve lost	• Committing a crime or considering
• Being unable to stop or control your betting	committing a crime to pay for gambling
• Borrowing money to gamble	• Feelings of hopelessness, depression, or
• Gambling to get money to solve financial	suicide
problems •

CONFIDENTIAL HELP AND SUPPORT

FREE, 24/7 Michigan Problem Gambling Helpline • Call: 800-270-7117 • Text 248-648-3363

The Michigan Problem Gambling Helpline provides FREE, confidential, one-on-one support to any Michigan resident seeking help for a gambling problem. Counselors are available to provide immediate assistance including screening services and referrals to treatment or support groups.

For additional problem gambling information and resources, please contact the Michigan Lottery’s Responsible Gaming Manager at (517) 335-5600

Problem Gambling Training

Problem gambling training available at: retailers.michiganlottery.com

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Complete the Convenience Store Liquor Party, GasConvenience Store Mass, Restaurant Drug Store Social Club, BarRestaurant Recreation Other, WRITE THE APPLICABLE MICHIGAN, Class C, Brewpub, SDM, SDD, ENTER THE HOURS OF OPERATION, Sunday, Monday, Tuesday, Wednesday, and Thursday fields with any information that can be required by the application.

michigan lottery form 5754 Convenience Store Liquor Party, GasConvenience Store Mass, Restaurant Drug Store Social Club, BarRestaurant Recreation Other, WRITE THE APPLICABLE MICHIGAN, Class C, Brewpub, SDM, SDD, ENTER THE HOURS OF OPERATION, Sunday, Monday, Tuesday, Wednesday, and Thursday fields to fill out

Indicate the essential information in Each ownershareholderprincipal oﬃ, SIGNATURE, TYPE OR PRINT TITLE, PERCENT OF STOCK, TYPE OR PRINT NAME OF INDIVIDUAL, SIGNATURE, TYPE OR PRINT TITLE, PERCENT OF STOCK, TYPE OR PRINT NAME OF INDIVIDUAL, SIGNATURE, TYPE OR PRINT TITLE, PERCENT OF STOCK, TYPE OR PRINT NAME OF INDIVIDUAL, SIGNATURE, and TYPE OR PRINT TITLE part.

stage 3 to filling out michigan lottery form 5754

The MICHIGAN LOTTERY RETAILER SERVICES, PERSONAL DATA SHEET, Business Name dba, EACH OWNER PARTNER PRINCIPAL, NAME LAST FIRST MI, MAIDEN NAME, SOCIAL SECURITY NO, DATE OF BIRTH, SEX, DRIVERS LICENSE NO, HOME ADDRESS NO STREET, CITY, STATE, ZIP, and COUNTY box will be the place to put the rights and responsibilities of either side.

MICHIGAN LOTTERY RETAILER SERVICES, PERSONAL DATA SHEET, Business Name dba, EACH OWNER PARTNER PRINCIPAL, NAME LAST FIRST MI, MAIDEN NAME, SOCIAL SECURITY NO, DATE OF BIRTH, SEX, DRIVERS LICENSE NO, HOME ADDRESS NO STREET, CITY, STATE, ZIP, and COUNTY in michigan lottery form 5754

End by reading the following fields and completing them accordingly: If you are not a US citizen are, YES, or do you have a Visa, YES, Have you ever legally changed, YES, From to, Have you ever been known by any, YES, Give names, Questions relate to criminal, Have you ever, YES NO, YES NO, and been arrested or detained.

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