Fillable Form Wl-108 - The Wisconsin Lottery Winner Claim Form (Page 2 of 2) in pdf

INFORMATION

Claimant Information:

You must provide your name, birth date, address, city, state, and zip code to

receive your check. For prizes of $600 or more, provide your social security number to facilitate the payment

of your prize. SIGN the back of your instant or lotto ticket and line 15 of this form.

All tickets are subject to the Features and Procedures of the individual game. Features and Procedures for

individual games are available upon request. The Lottery is not required to pay tickets that fail its validation

tests. Tickets submitted become property of the Lottery and will not be returned.

Disclosure of Social Security Number:

Your social security number will be used to report the amount

of your winnings to the Internal Revenue Service, as required under federal law. Your prize winnings are

subject to both federal and state income tax withholding:

• Federal taxes are deducted from prize payments of $5,001 or more

• State taxes are deducted from prize payments of $2,000 or more.

This may not be your entire tax liability; you may still owe more taxes at tax year end. Please consult your

tax advisor for further assistance.

Wisconsin Statutes 565.30(5) requires the Lottery to check social security numbers with the Department of

Revenue for claimants of all prizes of $1,000 or more. Before paying lottery prizes of $1,000 or more, the

Wisconsin Lottery is required to determine if the winner(s) of the lottery prize are delinquent in the payment

of Wisconsin taxes, child support or debts to other government entities. If you are found to be delinquent in

the payment of these liabilities, the amount due will be withheld from your winnings. If your prize is $1,000

or more, and you do not, or cannot, provide your social security number, you will not receive your check,

until after we have researched the Department of Revenue delinquency files. In addition, federal back‑up

withholding will be deducted from all prizes $600 or greater if your social security number is not provided.

Without a social security number, only checks $600 to $999 will be received on the day processed and will

have federal back‑up withholding deducted from the gross amount of the prize paid.

CASHING YOUR CHECK TODAY

If you are

, at the Wisconsin Lottery’s contracted bank,

you must alert validation staff when you receive your check, and they will notify the bank.

Expect a two hour delay for same day cashing of Lottery checks. The State’s contracted

bank reserves the right to determine the amount of CASH and other forms of payment that

are made available to you. Please note each bank has the right to establish policies and

requirements, including but not limited to multiple identifications and cash availability.

Multiple-Winner Ticket:

If more than one person is claiming the prize, check “Yes” on item 13 on the

front of this form.

• A court order is required when more than one person is claiming the prize. The court order must be

accompanied by a separate winner claim form for each person.

• Multiple‑winner tickets must be processed at the Madison office. Payment may take up to two weeks after

the court order is received by the Wisconsin Lottery.

• All claimants are subject to tax withholding pursuant to Wisconsin and federal law.

• For more information on sharing of lottery winnings, please refer to Publication 600, Wisconsin Taxation

of Lottery Winnings.

Prizes that have an annuity or cash option feature (multi‑million dollar jackpot games for example) must be

claimed at the Madison Lottery office. Contact Player Relations at (608) 261‑4916, for more information.

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Form Wl-108 - The Wisconsin Lottery Winner Claim Form Page 2

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