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Online Claim Form
Texas Lottery Winner Claim Form
Fill out this form online. Once you have filled it out, click the "Create Form" button and a printable version will be prepared. You may then print your claim form. All forms must be mailed in - no forms will be accepted electronically on this site.
*
Enter the information called for on the claim form in Items 4-18, as appropriate. (NOTE: If a U.S. Citizen or Resident Alien, a Social Security Number is required in order to receive a prize payment.)
*
Each ticket of $600.00 or more must be claimed on a separate form.
Multiple tickets of less than $600.00 may be combined and claimed on one form.
*
You may claim a prize at any Lottery Claim Center in person or by mail. Lottery Commission locations and address will be found on the next screen.
Texas Lottery Commission / ATTN: Austin Claim Center
PO Box 16600 / Austin TX 78761-6600
Phone: 1-800-37-LOTTO
PRIZE MONEY
4. Total prize value of claim
$
NUMBER OF TICKETS
5. Included with claim
6. Claimant Name
First Name
Last name
Middle Initial
7. Claiming as
Individual
Partnership
Corporation
Trust
Other
8. If claiming as a PARTNERSHIP, CORPORATION, TRUST, or OTHER:
Name & Title of Individual w/ Signatory Authority
9. If claiming as an INDIVIDUAL:
Are you either a United States citizen or a Resident Alien?
Yes
No
10. Date of Birth (INDIVIDUAL) or Date of Creation (PARTNERSHIP, CORP, TRUST, OTHER) (mm dd yyyy)
11. Social Security Number / FEIN
12. Mailing Address
Street Address and Street Name or PO Box
City
State
-
Zip Code
13. Country
14. County
15. Home Phone Number
-
-
16. Work Phone Number
-
-
17. How ticket acquired:
Purchased
Gift
Found
Other
(Explain)
18. Store name and City where ticket acquired:
19. Date ticket acquired (mm/dd/yyyy)
Accessible Version
Imprint
