Section 65IAC8-3-4. Form of claim

   (a) A prize claim shall be made on such form or forms as are prescribed by the director.

  (b) A prize claimant shall provide the commission with the following:

(1) The ticket upon which the claim is being made.

(2) The name, address, telephone number (if any), and a copy of a government issued photo identification, such as a driver's license or passport, for the following:

(A) the prize claimant;

(B) the ticket purchaser, if known; and

(C) any prize winner.

(3) For prize claims that exceed five hundred ninety-nine dollars ($599), the Social Security number or other tax identification number of:

(A) the prize claimant; and

(B) any prize winner.

  (c) Upon request, a prize claimant shall disclose to the commission, to the best of claimant's knowledge, where the ticket was purchased, the date purchased, and any other information necessary to establish the validity of the claim.

  (d) If prize claimant is a representative of a group under section 3(4) of this rule, then the prize claimant must file with its claim an Internal Revenue Service Form 5754, "Statement by Person(s) Receiving Gambling Winnings", or a successor form, with the commission designating to whom the prize is to be paid and the individual or individuals to whom the prize is taxable.

  (e) If prize claimant is a nonprofit corporation, the prize claimant must file with its claim the following:

(1) the nonprofit corporation's articles of incorporation;

(2) the names and addresses of its officers, members, delegates, and directors;

(3) evidence of the nonprofit's tax exempt status with the United States Internal Revenue Service;

(4) a disclosure of the amount and type of any compensation paid to officers, members, delegates, and directors;

(5) the nonprofit corporation's Internal Revenue Service Form 990 or comparable return for each of the past three (3) years; and

(6) a statement describing the charitable purpose of the nonprofit corporation.

  (f) If a nonprofit corporation filed the information required under subsection (e) with a previous claim and affirms in writing that the information is unchanged since the previous claim, the director or the director's designee may waive a requirement in subsection (e). (State Lottery Commission; 65 IAC 8-3-4; emergency rule filed Aug 10, 2010, 10:39 a.m.: 20100901-IR-065100542ERA; emergency rule filed Sep 22, 2010, 3:36 p.m.: 20100929-IR-065100618ERA; emergency rule filed Jun 28, 2013, 1:16 p.m.: 20130710-IR-065130299ERA)