The Virginia Lottery form is an essential document used to verify the age of individuals wishing to participate in Virginia Lottery programs. This form ensures that all players are 18 years of age or older, promoting a responsible gaming environment. Completing the form accurately is crucial, as it helps maintain the integrity of the Lottery and enhances the experience for eligible participants.
The Virginia Lottery form is an essential document for individuals looking to verify their age for participation in lottery programs. It requires users to fill out their information, which can be done electronically or by hand using a ballpoint pen. A crucial step is entering the six-digit verification code located in the upper right corner of the form. This form also includes a section that must be completed by a licensed notary, who will certify the individual's identity and age. Acceptable forms of photo identification include a driver's license, a government-issued ID, a U.S. passport, or a military ID. Once the form is filled out and notarized, individuals can either mail it along with copies of their ID and Social Security card to the Virginia Lottery Age Verification Program or visit a local Lottery office for assistance. The form emphasizes privacy, assuring users that their information will remain secure and not be sold to third parties. This verification process aims to enhance the overall Lottery experience by ensuring that only eligible players can participate in promotions.
Verification Code:
________________
VERIFICATION FOR VIRGINIA LOTTERY PROGRAMS
Please complete and review all of the information below. You may fill in the required information electronically and print, or
print this form and handwrite your information using a ball point pen. See page two of this document for additional instructions.
IMPORTANT: Please remember to enter your six-digit verification code in the upper right-hand corner of this form.
Legal Last Name
Legal First Name
Ml
Date of Birth
(month /day/year )
/
Social Security Number
Primary Telephone Number
Mobile Telephone Number (optional )
–
(
)
Home Address
Mailing Address
(if different from home address )
Street: ______________________________________________
City: ________________________________________________
State: _____________________ Zip Code: _______________
State: _____________________
Zip Code: _______________
MARK THE APPROPRIATE “YES” OR “NO” CIRCLE BELOW
(include email address)
I am at least 18 years of age or older.
O YES
O NO
The home address shown above is where I currently reside.
Email address: _______________________________________________________________
IMPORTANT: SIGN AND DATE IN THE PRESENCE OF A NOTARY
I affirm that the above information is true and correct:
Signature: ____________________________________________________________
Date: ______________________________
(Must be signed in the presence of a Notary)
(month/date/year)
THIS SECTION TO BE COMPLETED BY A LICENSED NOTARY
State of: _______________________________ City/County of: _________________________________________________________
I, ___________________________________ , a Notary Public, do hereby certify that on this ______ day of ______________ , 201___ ,
the above person appeared before me and provided photo identification and documentation that confirmed to me that he or she is
18 years of age or older. The above person has produced ________________________________ as a form of photo identification.
Notary Public, State of : _________________________________________
Name (typed or printed) : ________________________________________
PLACE
Notary Registration Number : ____________________________________
SEAL HERE
My Commission Expires : ________________________________________
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VAL-VF1.1.2017
INSTRUCTIONS FOR COMPLETING YOUR VERIFICATION FORM
Once you have completed all fields on the first page of this document and verified your information for accuracy, please perform one of the following steps:
1Bring the completed form to a local notary, along with your photo identification. Acceptable forms of ID include a Driver’s license; an ID card issued by the federal or local government that includes a photo, address & birth date; a U.S. passport; or a Military ID. Have the notary complete the bottom section of the form. Make a copy of the completed, notarized form for your records. Mail the original notarized form, a copy of your ID and a copy of your Social Security card to this address:
Virginia Lottery Age Verification Program
Longwood Village Shopping Center
1506 S. Main Street
Farmville, Virginia 23901
2Bring the completed form, your photo ID and your Social Security card to a Virginia Lottery office. There, a Lottery employee will be happy to help you complete the process. A list of Lottery offices is shown below:
Richmond Prize Zone
Shenandoah Valley
Roanoke Valley
600 E. Main Street
1790-26 E. Market Street
1287 Towne Square Blvd.
Richmond, VA 23219
Harrisonburg, Virginia 22801
Roanoke, Virginia 24012
(804) 692-7000
(540) 433-7979
(540) 561-7011
Richmond Prize Zone West
Hampton Roads
Southwest Virginia
1620 East Parham Road
2306-2308 W. Mercury Blvd.
408 E. Main Street
Richmond, Virginia 23228
Hampton, Virginia 23666
Abingdon, Virginia 24210
(804) 692-7950
(757) 825-7800
(276) 676-5540
Northern Virginia
Central Virginia
14550 Potomac Mills Road
Longwood Village
Woodbridge, Virginia 22192
Shopping Center
(703) 494-1501
(434) 392-7294
PRIVACY
Any information you submit is secure. The Virginia Lottery does not sell any information to other organizations. The use of this age verification service will create a better Lottery experience for all players because it will ensure that only those who are eligible can participate in Lottery promotions. Questions or concerns? Check http://www.valottery.com/age where you can view answers to commonly asked questions about the age verification process. Please feel free to call the Virginia Lottery at 804-692-7778 or send an email to info@valottery.com.
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