N.H. Admin. Code § Sw 301.01 - Required Information
Each applicant wishing to become a sales agent of the commission shall complete and submit the following as part of the application approval process to the New Hampshire lottery commission "(commission)":
(a) The "Sales Retailer Application" dated
January 06, 2009.
(b) The "Retailer
Agreement for Sale of New Hampshire Lottery Tickets" shall contain at a minimum
the following:
(1) The effective date of the
agreement between the commission and the name of the New Hampshire lottery
games retailer (retailer);
(2)
Signatures of the owner and lottery director, along with their printed names
and date(s) the agreement was signed; and
(3) Signature and date of witness to
agreement signing.
(c)
The "Board of Directors Member Listing" dated October 28, 2013 shall be
completed by all business structures licensed by the commission including sole
Proprietorships, Partnerships, corporations, Limited Liability Companies and
non-profit Corporations.
(d) Each
individual listed on the "Board of Directors Member Listing" shall submit the
following personal data on the application including name, address, social
security number, date of birth, home phone number, cell phone number, and
previous address (if living at current address less than 5 years), along with
their signature, a criminal record release authorization form, and a copy of a
photo identification.
(e) The
"State of New Hampshire Alternate W-9 Form" shall contain at a minimum the
following information:
(1) Name of the
business;
(2) Address of the
business;
(3) Taxpayer
Identification Number (TIN) as used on Internal Revenue Service tax
return;
(4) Principal activity of
the type of service or product provided;
(5) Designation of business structure which
applies to the organization as provided to the Internal Revenue Service;
and
(6) Name and title of
individual completing the form, along with his/her contact numbers and
signature.
(f) The
"Criminal Record Release Authorization Form" shall:
(1) Be completed by each applicant or partner
of the applicant including an owner, partner, member, manager or officer of the
business structure listed on the "Board of Directors-Member Listing" and on the
"Sales Retailer Application"; and
(2) Contain at a minimum the following:
a. Name;
b. Address;
c. Date of birth;
d. Hair color;
e. Eye color;
f. Sex;
g. Driver license number; and
h. Signature notarized and date
signed.
(g)
The "Authorization Agreement for Variable Withdrawals (ACH-Automated Clearing
House Debits)" required for weekly Electronic Fund Transfers (EFTs) shall
contain at a minimum the following:
(1) Name
of business;
(2) Tax ID
number;
(3) Name on checking
account;
(4) Signature of
authorizing party;
(5)
Date;
(6) Address of business;
and
(7) Agent number.
(h) Copy of voided check, or bank
verification if savings account.
Notes
#83, eff 12-18-73; ss by #1542, eff 3-24-80; EXPIRED: 3-24-86
New. #6551, eff 7-29-97, EXPIRED: 7-29-05
New. #8435, INTERIM, eff 9-21-05, EXPIRED: 3-20-06
New. #8610, eff 4-15-06
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