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Check «M box from eoch of the three Mctiwn: I) 26, 52 or 104 draws, 2) tosh option or onnuol payout, and 3) new or renewal Select your tlx lucky numbers by filling in the box (with pencil or pen) that has the number you wont played in it. OR (V it the “eosy pick' box to let the computer select six numbers for you. «.J I s O’ . ! • ^ 1 26 DRAWS (S26!
< . I 52 DRAWS ($52) | 104 DRAWS I $104) n O, I • CO I CASH OPTION
Q | ANNUAL PAYOUT hQ
| NEW _J | RENEWAL piay zm III2IXI mins iinm iinm slims
mini ii PUASI PRINT INFORMATION AIOUT PERSON RECEIVING SUISCRIPTION. Address . City_ State Dote of birth Daytime Phone (_)__ Evening Phone (_)_ Social Security#____ (Sociol Serunly Number not required to ploy Lotto By Moil but required if subsobei wins) _ U.S. Citizen □ Resident Alien ~ Alien C Group Subscription If A Gin, NAME OF GIVER Subscriber No. (hr renewals anfyl Please alow 3 weeks to process subscription
Jrn Fof more information call 1-800-354-mail (oM He lottery if you do not none confamalion of your uAmfpW\ effectne dob n Am mbs Subnotion amt be carried and *R be raid I your dwdi a money vdw s Subicnpmpurctaun I ram ore uAjed to lottery hits ad Rep**ons oad Stole Lews (epos on madaMt it ei Lottery offices ly purrhose of this subscription, you agree to be bound by the Rules end Regulations and winnws must In e Iwa || yen eld. Gift siksaipliom to mnors ore proNbOed Anyone waiving o sufascriplion must hem a Kkpnio moing address Al subscnpeons transactions end wimwn
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