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Get CO Lottery DR 9168 2019-2024

E items 1-11 and sign bottom of form. Fill out and sign back of ticket. 1. Claimant Type (Check one) Individual Individual claiming cash for a group IRS form 5754 MUST be attached to this claim form. Form 5754 will not be accepted at a later date. - 2. Social Security Number or FEIN *Name and Taxpayer ID# provided must match with IRS. - 3. LEGAL Name of Winner and Mailing Address Name printed here must exactly match name on ticket. Include spaces as needed. Last First MI Add.

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