MEGA MILLIONS SUBSCRIPTION APPLICATION

[Pages:2]MEGA MILLIONS SUBSCRIPTION APPLICATION

New York Lottery Subscription Program PO Box 7590 Schenectady, NY 12301-7590

1. SUBSCRIBER INFORMATION - Please print clearly

IMPORTANT: Subscriber must provide a New York State mailing address.

4 EASY STEPS

1. Complete ALL Subscriber Information.

Last Name (Subscriber or Group Representative)

First Name

Initial

2. Pick A plan - Choose ONE plan only. 1, 2, 3, or 4 games played twice a week. You can also play MEGAPLIER for a chance to multiply your winnings if you win second through ninth level prizes. MEGAPLIER doubles the price of your subscription.

Street Address Street Address City

N Y

State

Zip Code

3. CIRCLE 5 NUMBERS and 1 MEGA BALL for each game you play OR select the Area Code Telephone Number

Social Security Number

CIRCLE YES OR NO FOR EACH QUESTION

Quick Pick option for random computer

Are you a New York City resident?

generated numbers that will remain in effect for the length of your plan.

Date of Birth (mm/dd/yyyy)

E-mail Address

YES NO

GROUP - If you are representing a group, enter the group name below and list group members on back. Are you a Yonkers resident?

4. PAYMENT - Enclose a check or money

order for the exact amount of your plan.

YES NO

See step 2 for the cost of the plan chosen.

Allow approximately 15 business days for processing. A Confirmation will be mailed prior to the effective date of your subscription. Completion of this application certifies that each purchaser is 18 years of age or older.

2. PICK YOUR PLAN CHECK ONE BOX ONLY - 2 drawings per week (Tuesday and Friday)

1 GAME PER DRAWING

MEGA MILLIONS

52 DRAWS

$52

104 DRAWS

$104

MEGA MILLIONS WITH MEGAPLIER

52 DRAWS

$104

104 DRAWS

$208

2 GAMES PER DRAWING

52 DRAWS

$104

104 DRAWS

$208

52 DRAWS

$208

104 DRAWS

$416

3 GAMES PER DRAWING

52 DRAWS

$156

104 DRAWS

$312

52 DRAWS

$312

104 DRAWS

$624

4 GAMES PER DRAWING

52 DRAWS

$208

104 DRAWS

$416

52 DRAWS

$416

104 DRAWS

$832

3. CIRCLE 5 NUMBERS and 1 MEGA BALL NUMBER or CHOOSE QUICK PICK

GAME 1 (circle 5)

QUICK PICK

1 2 3 4 5 6 7 8 9 10

11 12 13 14 15 16 17 18 19 20

21 22 23 24 25 26 27 28 29 30

31 32 33 34 35 36 37 38 39 40

41 42 43 44 45 46 47 48 49 50

51 52 53 54 55 56 57 58 59 60

61 62 63 64 65 66 67 68 69 70

71 72 73 74 75

GAME 2 (circle 5)

QUICK PICK

1 2 3 4 5 6 7 8 9 10

11 12 13 14 15 16 17 18 19 20

21 22 23 24 25 26 27 28 29 30

31 32 33 34 35 36 37 38 39 40

41 42 43 44 45 46 47 48 49 50

51 52 53 54 55 56 57 58 59 60

61 62 63 64 65 66 67 68 69 70

71 72 73 74 75

GAME 3 (circle 5)

QUICK PICK

1 2 3 4 5 6 7 8 9 10

11 12 13 14 15 16 17 18 19 20

21 22 23 24 25 26 27 28 29 30

31 32 33 34 35 36 37 38 39 40

41 42 43 44 45 46 47 48 49 50

51 52 53 54 55 56 57 58 59 60

61 62 63 64 65 66 67 68 69 70

71 72 73 74 75

GAME 4 (circle 5)

QUICK PICK

1 2 3 4 5 6 7 8 9 10

11 12 13 14 15 16 17 18 19 20

21 22 23 24 25 26 27 28 29 30

31 32 33 34 35 36 37 38 39 40

41 42 43 44 45 46 47 48 49 50

51 52 53 54 55 56 57 58 59 60

61 62 63 64 65 66 67 68 69 70

71 72 73 74 75

MEGA BALL (circle 1) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

MEGA BALL (circle 1) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

MEGA BALL (circle 1) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

MEGA BALL (circle 1) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Note: If fewer than 5 numbers are circled in any game, additional number(s) will be randomly assigned. If a Mega Ball is not chosen, one will be randomly assigned. Numbers chosen in excess of what is

required to process this application will be disregarded.

REV. 11/4

4. PAYMENT CHECK OR MONEY ORDER

Check or money order (payable to NY Lottery) enclosed for $ ______________.

Check or money order number: ____________

IMPORTANT: The individual Subscriber or Group Representative must provide a mailing address within New York State since Federal Law prohibits mailing a Lottery confirmation across state lines.

COMPLETE ONLY IF GROUP

Group Information - please print clearly

Starting with the group representative, list the names, addresses and social security numbers of all group members in the spaces below. A maximum of 10 members per group is allowed.

Be sure to mark Yes or No to both of the questions for each group member. 1. Is the member a New York City resident? 2. Is the member a Yonkers resident?

Prizes of $600 or less will be creditted to the Group Representative's account and can be used to reduce the cost of future subcriptions or can be paid by check for distributrion to the group members. Prizes greater than $600 will be divided in equal shares and paid to each member of the group. The Lottery is not responsible for disputes between or among group members.

Member Name

Address

City

ST ZIP Social Security

Number

1.

NY

Question

1

2

Y NY N

2.

3.

4.

5.

6.

7.

8.

9.

10.

Mega Millions Jackpot Prize Payment Jackpot winners must make arrangements to receive their prize and are required to have a media announcement. If you win the Jackpot, you will have 60 days from the date the Lottery provides you with a Jackpot Claim Form to decide if you prefer 30 Annual Payments or a Lump Sum Payout. Those values are established via Mega Millions rules and will be presented to you by the Lottery shortly after a jackpot win.

Prize Information If you match 5 numbers plus the Mega Ball and win the jackpot, you will be notified by a Lottery representative to make arrangements to receive your prize. Prizes over $600 will be mailed to you. Smaller prizes will be automatically credited to your Subscription Center prize account. You can view your prize winnings through the Subscription Center at . You will be able to use your prize credits to reduce the cost of your next subscription purchase or request a cash-out of your prize credits at any time.

MEGAPLIER? Option By selecting MEGAPLIER you can multiply your non-Jackpot winnings by 2, 3, ,4 or 5. Prior to each drawing, a MEGAPLIER mutiplier is randomly selected and non-Jackpot prizes are multiplied by that amount. MEGAPLIER doubles the cost of your subscription.

Taxes The Lottery is required to report and withhold taxes according to the regulations of the Internal Revenue Service and the New York State Department of Tax and Finance.

Revisions The NewYork Lottery reserves the right to suspend or cancel any drawing or the game itself, change the prize structure, frequency of draws or draw dates. In the event of such a change, all subscribers will receive participation in a revised game, equivalent in value to the remainder of their subscription, or a refund, at the sole option of the Lottery.

Personal Information Notice To process your prize claim, you authorize the New York Lottery to collect personal information about you. You authorize the NewYork Lottery to use and release certain personal information, including your name, hometown and any photograph, video or audio recording, in any medium (including but not limited to newspaper, television, radio and internet), for purposes of marketing, advertising or purposes of the New York Lottery. If you do not provide all or any part of the personal information requested, your claim might be denied and you might not be awarded a prize. The New York Lottery is requesting this personal information pursuant to its authority under Tax Law Section 1604 to operate and administer the New York Lottery which includes the marketing and advertising of the New York Lottery and the identification of the person entitled to a prize award. Your personal information will be maintained by the Lottery's Prize Payment Unit. The Director of Prize Payment is the custodian of such records and may be contacted by mail at One Broadway Center, POB 7533, Schenectady, New York 12301-7533 or by phone at (518) 388-3370.

Prizes/Chances of Winning

Winning Numbers

Prize

Matched Per Game Chances of Winning

Level

Upper Lower

Per Game

Section Section

First

5

Second

5

Third

4

Fourth

4

Fifth

3

Sixth

3

Seventh

2

Eight

1

Ninth

0

1

1: 258,890,850

0

1: 18,492,204

1

1: 739,688

0

1: 52,835

1

1: 10,720

0

1:

766

1

1:

473

1

1:

56

1

1:

21

Overall Odds of Winning on a $1 play - 1:14.71

Prize

JACKPOT* $ 1,000,000**

$ 5,000** $ 500** $ 50** $ 5 $ 5 $ 2 $ 1

2X

$ 2,000,000** $10,000** $ 1,000** $ 100** $ 10 $ 10 $ 4 $ 2

MEGAPLIER MULTIPLIERS

3X

4X

5X

MEGAPLIER DOES NOT APPLY TO THE JACKPOT

$3,000,000**

$ 4,000,000**

$ 15,000**

$ 20,000**

$ 1,500**

$ 2,000**

$ 150**

$ 200**

$ 15

$ 20

$ 15

$ 20

$ 6

$ 8

$ 3

$ 4

$ 5,000,000** $ 25,000** $ 2,500** $ 250** $ 25 $ 25 $ 10 $ 5

*Note: The jackpot prize will be divided equally among multiple jackpot winners. All other prizes are a fixed payout amount, except as set forth below. **In some cases, the fixed prizes may be paid on a pari-mutuel basis and may be lower than these published amounts. The maximum prize liability for any Mega Millions drawing, excluding jackpot prize carry-forward, is 300% of sales or 50% of sales plus $50,000,000, whichever is less. In the event that maximum prize liability is exceeded, prize levels 2 and 3 will be adjusted to reflect the pari-mutuel calculated amount.

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