Claim Form

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Texas Lottery Winner Claim Form
(For use by individual claimants only)


	Please do not use your browser's print function. Complete this form online. After you enter your information, click the "Submit and Print" button and a printable version will be prepared. You may then print your claim form. All forms must be mailed in, along with your winning ticket(s) - no forms will be accepted electronically on this site.
	•	Enter the information called for on the claim form in Items 6-16, as appropriate. (NOTE: If a U.S. Citizen or Resident Alien, a Social Security Number is required in order to receive a prize payment of $25.00 and over.)
	•	Each ticket of $600.00 or more must be claimed on a separate form. Multiple tickets totaling less than $600.00 may be combined 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


6.	Claimant Name	LAST
		FIRST		MIDDLE INITIAL
7.	Citizenship/Residency (For tax purposes only.) U.S. Citizen	Yes No
	If "No," Country of Origin:
8.	Social Security Number	- -
9.	Date of Birth
10.	Mailing Address
	Street number and street name or PO Box
	City		State	- Zip code
11.	County
12.	Home or Cell	- -
13.	Work Phone #	- -
14.	I purchased the ticket It was given to me I found the ticket Other (explain)
15.	If purchased, store name and city where ticket purchased:
16.	Date you received the ticket: