Get Retailer Change Of Ownership Form - Hoosier Lottery

Filling out the Retailer Change of Ownership Form for the Hoosier Lottery is essential for ensuring the smooth transition of ownership for retailers. This guide provides clear instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the Retailer Change of Ownership Form and open it in your document editor.
2. In the Selling Retailer Information section, enter the Old Retailer number.
3. Fill in the Old Owner Withdrawal Date, indicating the specific date the retailer will cease selling Lottery products.
4. Indicate whether the retailer is part of a chain by selecting 'Yes' or 'No.' If 'Yes,' provide the Chain number.
5. Select the Type of License from the options provided, including Instant Only, Instant / On-Line, Instant / Pull-Tab, Instant / On-Line / Pull-Tab, or On-Line.
6. Enter the Selling Retailer's Business Name and the Business Address, including the City and Zip code.
7. The Selling Owner must sign and date the form in the designated area.
8. In the Purchasing Retailer Information section, complete the New Retailer number and New Ownership Effective Date.
9. Enter the New Retailer Name.
10. After signatures are obtained, fax a copy to Licensing immediately.
11. The form is complete once all fields are filled. Save changes, download, or print the form as necessary.

Begin filling out your document online today for a seamless ownership change.