Wisconsin Lottery
Winner Claim Form
Player Hotline: 608-261-4916 | www.wilottery.com
WL-108 (R. 4-24)
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Instructions to Claimant
• Verify your ticket is a winner at a Lottery Retailer or by
scanning the ticket with the Wisconsin Lottery mobile app.
• By law, only the original ticket is valid to claim a prize.
• SIGN the ticket(s) and Winner Claim Form in black or blue ink.
• Read and fully complete this entire Winner Claim Form.
• Provide government, state, or tribal-issued picture identication.
• A Social Security Number (SSN), Individual Taxpayer
Identication Number (ITIN), or properly completed Internal
Revenue Service (IRS) Form W-8BEN is required by law for
prizes of $600 or more.
• Tickets winning $200,000 or more must be claimed in person
at the Madison Oce. Claimant must arrive before 2:00 p.m.
• Multiple Claimants: see back for details.
Prizes
PO Box 777
Madison, WI 53774
I understand that any person who, with intent to defraud, falsely makes, alters, forges or counterfeits a state lottery ticket is in violation of state criminal law. It is a class
I felony to alter or forge a Lottery ticket or share or intentionally utter or transfer an altered or forged Lottery ticket or share, punishable by imprisonment of not more
than 3 years and 6 months and/or a ne of not more than $10,000, Wis. Stats. 565.50(2). It is also a crime to possess an altered ticket with intent to defraud punishable
by a ne of not more than $10,000 or imprisonment of not more than 9 months or both, Wis. Stats. 565.50(3).
I understand that Wisconsin Open Records law, (sec. 19.31-19.39 Wis. Stats.), provides the Lottery may disclose a winner’s name, likeness, and place of residence.
Upon claiming a prize, my name, likeness, and place of residence may be used for any purpose without compensation to me and I waive any claims against the Lottery
for any liability which may result from the disclosure of such information.
I have read the Winner Claim Form Instructions and understand my rights and responsibilities as a Lottery winner. I hereby certify that all information provided is true
and correct.
Lottery Use Only
Form Reference Number:
Lottery Use Only
Claim Date:
CF Test (Lotto tickets $5,000 or more): Pass
Fail
Security Referral: Referral Type:
Disposition:
Release Date:
Processor Initials
Investigator Initials
Notes:
Oce
DateClaimant Signature
Individual Claimant Information
1. First Name 2. M.I. 3. Last Name 4. Sux
5. Mailing Address (include Apt. #, Unit, Lot, Trlr, etc.)
13. Tax Status (select one)
US Citizen
Resident Alien
7. State 8. Zip Code6. City
10. SSN/ITIN or IRS Form W-8BEN
9. Phone Number
(xxx-xxx-xxxx)
12. Email
Government, State or Tribal Issued ID Number
14. Total Number of Tickets
16. Is prize being claimed by more than one person?
....................................................... Yes No
If yes, you acknowledge a court order is required to process the claim for multiple winners, per Wis. Stats. 565.30(1).
11. Date of Birth (mm-dd-yyyy)
15. Total Amount Claimed
ID Expiration DateState/Entity of ID Issuance
Additional Instructions for Mail-in Claims Only
• The Wisconsin Lottery is not responsible for tickets or Winner
Claim Forms lost in the mail.
• Certied or registered mail is suggested.
• Retain a copy of both sides of the signed ticket and
completed Winner Claim Form for your record.
• Normal processing time for prize claims is up to three weeks
once received.
Mail completed Winner Claim Form (page 1) with original
signed ticket(s) to the following address:
Prizes
PO Box 777
Madison, WI 53774
Non-Resident Alien/
Country of Citizenship:
Continued on Back
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Ticket Information
Verify your ticket is a winner at a Lottery
Retailer or by scanning the ticket with the
Wisconsin Lottery mobile app.
Tickets that are expired cannot be paid by
law, Wis. Stats. 565.30(3)(a).
A signature is required on the backside of the
original ticket, and on the Winner Claim Form.
Only one individual may sign.
All tickets are subject to the Features and
Procedures of the individual game. Features
and Procedures for individual games are
available at www.wilottery.com.
The Wisconsin Lottery reserves the right
to deny the payment of any ticket that fails
validation requirements. Tickets submitted
become the property of the Lottery and will
not be returned.
Claimant Information
To claim a prize and receive payment, a
claimant is required, by law, to provide their
legal name, birth date, current address
(including city, state, and zip code), and
citizenship status. For prizes of $600 or
more, a SSN, ITIN, or a properly completed
IRS Form W-8BEN is required to process the
payment.
Pursuant to Wisconsin’s Open Records law
(sec. 19.31-19.39 Wis. Stats.), upon request,
the Lottery is required to disclose a winner’s
name, likeness, and place of residence. If
you win and claim a prize, the Lottery may use
your name, likeness, and place of residence
for any purpose without compensation to
you. Upon claiming your prize, you waive
any claims against the Lottery and its
representatives for any and all liability which
may result from the disclosure or use of such
information.
If you or someone you know has a gambling
problem, call 800-GAMBLE-5 (800-426-2535)
or TEXT (850) 888-HOPE.
Tax Liability
The SSN, ITIN, or properly completed IRS
Form W-8BEN you provide will be used to
report the amount of your winnings to the
Internal Revenue Service (IRS), as required
under federal law. All prize winnings are
subject to both state and federal income tax
withholding. Claimants for prizes $600 or
more on a single play will receive a tax form
the calendar year following the year of their
claim.
• State taxes are deducted from single play
prizes of $2,000 or more
• Federal taxes are deducted from single
play prizes of $5,001 or more
Please consult a tax advisor for assistance
in determining your entire tax liability.
Withholding of Delinquent State
Taxes, Child Support, or Debts Owed
to the State
Wisconsin law (Wis. Stats. 565.30 (5)) requires
the Lottery to check social security numbers
(SSN) or Tax Identication Numbers (ITIN)
with the Department of Revenue for claimants
of all prizes $600 or more to determine if the
winner of a Lottery prize is delinquent in state
taxes, child support, or debts owed to the
state. If a claimant is found to be delinquent in
any of the above, the amount will be withheld
from the Lottery winnings.
Download the
Wisconsin Lottery
Mobile App
Scan to check your
ticket, create digital
playslips, save favorite
numbers, search
locations, and more.
Follow @WiLottery Online
The Wisconsin Lottery has provided funding for
property tax credits since 1988.
The following must be processed at the
Madison Lottery Oce:
• Multiple Winner Claims
◦ See Multiple Winner Checklist at wilottery.com
• Prizes $200,000 or more must be claimed in
person
Sign Your Ticket
Walk-in Locations
Arrive by 3:30 p.m. to ensure enough time for
claim processing.
Prizes of $50,000 or more: Arrive at the
Lottery oce no later than 2:00 p.m.
Powerball, Mega Millions, and Megabucks
jackpot winners: Call ahead and make an
appointment.
Contact the Player Hotline at 608-261-4916
or visit www.wilottery.com for additional
information.
Wisconsin Lottery
Winner Claim Form Instructions
Redeem All
Prize Amounts
Madison Ofce
Wisconsin Lottery
Department of
Revenue
2135 Rimrock Rd
Redeem Prizes
Up to $199,999
Milwaukee Ofce
State Oce Building
4th Floor Service
Center*
819 N 6th St
*use James Lovell St. entrance
Hours: Monday - Friday 8 a.m. - 4 p.m.
