Name
Address
City State County
Zip
E-mail
Telephone
Date of Birth Country of Birth Country of citizenship
Number of dependents
Do you owe any back Taxes? Yes No
Are Currently Employed? Yes No
Have you ever been convicted of a criminal act? Yes No
*If yes please state the nature of the offense
Do you have a valid Government issued ID? Yes No
What is your marital status?
Married Single Divorce Widow
What was your occupation?
Annual Household Income?
Are you the owner of your home? ( Yes No
Are you the one who take cares of your own finances? ( Yes No )
Do you currently have investments, such as stocks, bonds, annuity, 401(k)s, or IRA? ( Yes No )
*I guarantees that all the above information is true and factual in its entire content and understands that any false information or failure to comply may lead to my prize money being barred by the IRS.
Signature of Applicant Date
Signature of Remittance Co
Signature Agent (IRS)
This form is to certify that you willingly accept your grand prize winnings under the terms and conditions of the board of directors. Before signing up and returning this form you must read, understand and accept all rules, regulations and procedures suggested in all the information.
I have read, understood and agreed to all terms and conditions. I hereby, give full consent in the acceptance of this award from the Mega Million Sweepstakes Association.
Photo:
Signature
Claim Manager: Mr. David Snyder
First Name, Middle Initial, Last Name
Street, City, Province/State or P.O Box
Please sign and complete the claim form as well as dating the bottom. Please staple your transaction receipt together with your acceptance form. We strongly encourage you to send your winning claim form by certified or priority mail or by another means to track your claim form delivery to our office. You are selected as a winner once you have received a CLAIM ID number, validated by the Mega Million Sweepstakes Processing Department.
Amount of Prize $7,000.00 - $8,500,000.00
Gift Tax Registration Fee
Authorization & Release
IRS / CRA TAX
Certification: Under penalty of perjury, I hereby declare that, to the best of my knowledge and belief, the name, address provided correctly identifies me as the claimant of this prize and that the claimant is not prohibited by law from playing the Mega Million Sweepstakes. I understand that any person who, with the intent to defraud, falsely presents for payment a forged, counterfeit, or altered ticket is in violation of state law and may be prosecuted or will be referred for prosecution.
Instructions for claiming your winnings:
How to Claim-To claim a prize of $5,000.00 or more, you can use any of the methods below to claim your Super Prize. You should make a copy of your CLAIM ID along with the completed claim form for your records.
A. By Prize Patrol Team – Please have your Acceptance Form, with a valid form of a government issued identification card such as a driver’s license/passport issued by the United States or Canada; an identification card issued by any branch of the armed forces of the United States/Canada or an identification card issued by the United States/Canada Bureau of Citizenship & Immigration Services, in hands to verify to the prize patrol team upon your delivery at your resident. Also, with your (Gift Tax Payment Receipt) which will be explained to you by your assigned Claim Agent.
B. By mail or Courier – Complete this claims form as well as the (Gift Taxes Registration Payment transaction). Please add the CLAIM ID number to the completed Acceptance form to validate with the prize patrol team. We strongly urge you to send winning claim form by certified or express mail along with tax payment. ALWAYS REMEMBER TO OPEN A NEW ACCOUNT WITH YOUR BANK TO RECEIVE FUNDS TRANSFER.
Gift Tax Registration Fee - A gifted tax registration fee is required by the Federal Government, which needs to be paid ahead of time before receiving a delivery from the Mega Million sweepstakes Company Prize Patrol Team. This allows the state and FDIC to approve the funds to be deposited with any financial institution of the winner’s choice, any winner who may fraudulently claim that they have paid this fee of 1% or refuse to pay this fee, will not be qualified to receive his/her prize winnings from the Mega Million sweepstakes.
Time for processing claim –
Fill out your claim form once you agree to claim your award. Winners are advised to process a Wire Transfer, Certified Cashier’s Check or Direct Deposit, in order to cover all tax payments.
PRIVACY POLICY - Mega Million Sweepstakes respects your privacy. We take seriously our obligation to protect the information or "data" about you that we collect, process or share with the (IRS/CRS). This Privacy Policy governs all information and digital properties owned or operated by MMS ("Company") and applies to all registrants, entrants, to avoid "DISQUALIFICATION" This is strictly a surprise winner are not allowed to notify any individual, bank attendant, relatives or visitors until your prize is safely awarded to your home address. This information is provided to protect each winner from getting involved with any kinds of “UNNECESSARY CONFUSION” only winners can and should have access to this claim document.
For questions regarding claiming a prize, please contact the Mega million sweepstakes at: (725) 326-7886
The U.S/CANADA has a multi-tier income tax system under which taxes are imposed by federal, state/province and sometimes local governments. Federal and state income taxes are similar in that they apply a percentage rate to taxable incomes. However, they differ considerably regarding those rates and how they're applied. Also, the Mega million sweepstakes is required to notify other state agencies of this claim and withhold any portions of a claimant's winnings if the claimant owes an outstanding debt to a state agency
Yours Sincerely,
Deborah Holland
Executive Vice President
