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{\author Karen Knott}{\operator George Karl}{\creatim\yr2003\mo2\dy13\hr15\min51}{\revtim\yr2003\mo2\dy13\hr15\min51}{\version2}{\edmins0}{\nofpages1}{\nofwords96}{\nofchars551}{\*\company Pino Training Organization}{\nofcharsws676}{\vern16411}}
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Lottery Payments Submission Worksheet
\par }{\f1\fs24 
\par }\pard \nowidctlpar\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 
\par }\pard \nowidctlpar\tldot\tx4680\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\b\f1\fs24 CCFC/Referral Representative Information
\par }\pard \sl360\slmult0\nowidctlpar\tldot\tx4680\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\b\f1\fs24 
\par }\pard \sl360\slmult0\nowidctlpar\tlul\tx6930\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 Name\tab  Date\tab 
\par }\pard \sl360\slmult0\nowidctlpar\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 Company\tab \tab 
\par Address \tab \tab 
\par }\pard \sl360\slmult0\nowidctlpar\tlul\tx4680\tx5040\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 City\tab  State ____________ ZIP\tab 
\par Phone \tab  Fax\tab }{\b\f1\fs24 
\par }\pard \sl360\slmult0\nowidctlpar\tldot\tx4680\tx5040\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 
\par }\pard \nowidctlpar\tldot\tx4680\tx5040\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\b\f1\fs24 Client (Lottery Winner) Information}{\f1\fs24 
\par 
\par }\pard \sl360\slmult0\nowidctlpar\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 Name\tab 
\par Address \tab 
\par }\pard \sl360\slmult0\nowidctlpar\tlul\tx4680\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 City\tab  State ____________ ZIP\tab }{\f1\fs24 
\par }\pard \sl360\slmult0\nowidctlpar\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 Phone \tab \tab }{\b\f1\fs24 
\par }\pard \sl360\slmult0\nowidctlpar\tldot\tx4680\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 
\par }\pard \nowidctlpar\tldot\tx4680\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\b\f1\fs24 Prize Information}{\f1\fs24 
\par }\pard \sl360\slmult0\nowidctlpar\tldot\tx4680\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 
\par }\pard \sl360\slmult0\nowidctlpar\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 State making payments on the winnings \tab 
\par Exact date prize was won\tab 
\par Exact total amount won \tab 
\par Exact annual payment date \tab 
\par Exact total annual payment amount after tax withholding \tab 
\par 
\par }\pard \nowidctlpar\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\b\f1\fs24 Client\rquote s Need}{\f1\fs24 
\par 
\par }\pard \sl360\slmult0\nowidctlpar\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 What is the client\rquote s motivation?\tab 
\par How much cash does the client need? \tab 
\par }\pard \sl360\slmult0\nowidctlpar\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 
\par }\pard \nowidctlpar\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\i\f1\fs24 Please attach a copy of the document the client received notifying him or her of the prize and a copy of the winner\rquote s W-2G tax reporting form.}{\f1\fs24 
\par }\pard \sl360\slmult0\nowidctlpar\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 
\par }{\f1 /lottery}{
\par }}