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- Click ‘Get Form’ to open it in the editor.
- In the Event Information Section, enter the name of the event where the prize was awarded, followed by its location and date.
- Move to the Prize Information Section. Provide a brief description of the item won and indicate its Fair Market Value (FMV), based on whether it was purchased or donated.
- Next, fill out the Winner Contact Information Section. Enter the winner's name, Social Security Number (SSN), full mailing address, phone number, and email address.
- Finally, complete the Certification Section by having a WIU employee sign and date the form to confirm that all information is accurate.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2010 | 4 Satisfied (46 Votes) |
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