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Get AK Form 874 2013

D for each prize of $50.00 or more. Type of Activity PRIZE RECEIPT Amount Won This receipt is required for each prize of $50.00 or more. Type of Activity (OTHER THAN PULL-TABS AND BINGO) This receipt is required for each prize of $50.00 or more. Type of Activity Date Won Name of Prize Winner Amount Won Name of Prize Winner Mailing Address $ Name of Prize Winner Mailing Address City, State, Zip $ Mailing Address City, State, Zip Telephone Number $ City, State, Zip Telephone Number.

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