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Claim Form

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Claim Form
Claim Rules
  • Enter only winning tickets below.
  • Multiple tickets totaling less than $600 each may be combined on one claim form not exceeding 100 tickets.
  • The claim form may not be used for prizes of $1 million or more, jackpot prizes and/or annuity prizes.
  • Claims submitted by minors are not supported by the form.

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Total Prize Value: $0


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