Pursuant to the New Jersey Lottery Law (N.J.S.A. 5:9-1 et seq. and N.J.A.C. 17:20-1 et seq.) ("New Jersey Lottery Law"), holders of winning tickets or shares may remain anonymous indefinitely. The identity of a holder choosing to remain anonymous shall not be included under materials available to public inspection pursuant to the New Jersey Lottery Open Public Records Act (N.J.S.A. 47:1A-1 et seq. and N.J.A.C. 17:20-7.7). By authorizing the New Jersey Lottery and its agents, representatives and designees to use your name, town and state of residence, prize amount, and photographic and video-graphic likeness (collectively “Likeness”), you agree to hold harmless the New Jersey Lottery and its agents, representatives and designees, and its/their respective employees, for any unauthorized use or misuse of your Likeness.
The Federal Privacy Act (Public Law 93-579), 5 U.S.C. §552a, requires that this notice be provided when collecting personal information from individuals.
Disclosure Requirement: Each claimant submitting this form for payment of winnings shall furnish to the Lottery the information required on the Internal Revenue Service ("IRS") Form W-2G (or any other form required by the IRS), including but not limited to the claimant's: (i) name; (ii) address; (iii) social security number; and (iv) prize amount. This disclosure is mandatory and such information will be disclosed by the New Jersey Lottery to the IRS for tax withholding and reporting purposes pursuant to 5 U.S.C. §522a(b)(3); 26 U.S.C. §§3402(q), 6011, 6041, 6103(h)(1), and 6109; 42 U.S.C. §405(c)(2)(C); 26 C.F.R. §31.3402(q)-1; N.J.S.A. 54:50-8 and -9; N.J.A.C. 17:20-7.1, and any regulations thereunder.
The New Jersey Lottery will also disclose this information for purposes of identifying child support, public assistance, student loan, and other state debt obligors for possible prize garnishment pursuant to 42 U.S.C. §405(c)(2)(C); N.J.S.A. 5:9-13.1, -13.5, -13.14 and -13.17; N.J.A.C. 17:42-1.2; N.J.S.A. 17:43-1.2, and any regulations thereunder.
By initialing Box 8 on the form, you voluntarily consent to Lottery providing your social security number to the additional state agencies. Providing your social security number to these agencies will speed the New Jersey Lottery's ability to process and validate your claim. Nothing in the New Jersey Lottery law section N.J.S.A. 5:9-7(b) and associated regulations shall be construed to prevent the conduct of data exchange among authorized State and Federal entities.