1 Broadway Center, Schenectady, NY, 12305, US
The submission of a Lottery Retailer License Application does not guarantee that a license will be issued. Selection of your business as a Lottery Retailer location is within the discretion of the Lottery, depending on the Lottery's judgement regarding:
(1) the volume of expected sales;
(2) the financial responsibility and security of the business;
(3) the accessibility of the place of business to the public;
(4) the sufficiency of existing licenses to serve public convenience, and
(5) whether the place of business is predominantly frequented by minors.
It is not necessary to employ any person, agency or organization to assist you in filling out this application. Beware of persons claiming to be able to assist you in securing a Lottery Retailer License.
The payment or offer of money or other items of value to influence approval of a Lottery Retailer License is a criminal offense, and offenders will be prosecuted.
Please note that all fields in the following application marked with (*) are required and must be completed.
BUSINESS CONTACT INFORMATION
If you require assistance, contact us at: Lot.firstname.lastname@example.org
PRIOR NEW YORK LOTTERY LICENSE HISTORY
PLEASE LIST ALL BUSINESSES CURRENTLY OR PREVIOUSLY OWNED BY YOU (OR ANY OF THE PRINCIPALS OF THE BUSINESS) THAT HAVE (OR HAVE HAD) A NEW YORK LOTTERY RETAILER'S LICENSE:IF YOU HAVE NEVER OWNED A BUSINESS THAT WAS LICENSED TO SELL THE NEW YORK LOTTERY, PLEASE CLICK NEXT AT THE BOTTOM OF THIS PAGE.
BUSINESS ADDRESS INFORMATION
BUSINESS MAILING ADDRESS INFORMATION
9-DIGIT NEW YORK STATE TAX IDENTIFICATION NUMBER (AS IT APPEARS ON YOUR CERTIFICATE OF AUTHORITY) *
DO NOT ENTER HYPHENS, DASHES OR SPACES
9-DIGIT FEDERAL EMPLOYER (FEIN) OR FEDERAL TAX IDENTIFICATION NUMBER (TIN): *
FOR INDIVIDUALS/SOLE PROPRIETORS, SOCIAL SECURITY NUMBER (SSN)
FOR OTHER ENTITIES, EMPLOYEE IDENTIFICATION NUMBER(EIN)
DO NOT ENTER DASHES OR SPACES
NEW YORK STATE LIQUOR LICENSE NUMBER (SLA) (If Applicable)
If You Rent, Please Complete the Following:
ELIGIBILITYOnly citizens of the United State or aliens lawfully residing in the United States are eligible to be licensed as New York Lottery Retailers. An alien who holds a New York Lottery Retailer License must notify the New York Lottery of any change in his/her immigration status.Failure to do so may result in a suspension or revocation of the New York Lottery Retailer License(s).
For business entities other than sole proprietors, all partners and corporate officers MUST be listed and Ownership percentages must add up to 100%.
If there is only one owner, please scroll down to the bottom of this page and click "Next"
If there are no more owners, please scroll down to the bottom of this page and click "Next"
The Total Ownership Percentage must equal 100.
Please ensure that the Ownership Percentages shown below are correct and equal 100 before continuing.
For Owner #1, you entered the number below as their Percentage of Ownership
For Owner #2, you entered the number below as their Percentage of Ownership
For Owner #3, you entered the number below as their Percentage of Ownership
A background investigation is conducted for each principal of the business. If you or any other principal of the business has been convicted of any criminal offense or has been arrested or charged for any crime, offense or violation in which action is still pending or resolved (disposed), you must submit a separate statement.
Failure to disclose any such involvement will be taken into account in assessing your character, honesty and integrity. The New York State Gaming Commission will compare the information you provide with criminal records maintained by Federal and State law enforcement agencies.
Procedures for obtaining a copy of FBI criminal history record are set forth at Title 28, Code of Federal Regulations (CFR), Section 16.30 through 16.33 or go to the FBI website at http://www.fbi.gov/about-us/cjis/background-checks. Procedures for obtaining a change, correction, or updating of an FBI criminal history record are set forth at Title 28, CFR, Section 16.34 or go to the FBI website at http://www.fbi.gov/about-us/cjis/identity-history-summary-checks/challenge-of-an-identity-history-summary
An applicant may obtain, review and, if necessary, seek correction of his/her criminal history pursuant to New York State DCJS regulation (9NYCRR Part 6050). To obtain further information through procedures established by DCJS, visit http://www.criminaljustice.ny.gov/ojis/recordreview.html
ACCESSIBILITY & BUSINESS ENTERPRISE
By submitting this application, you will be deemed to have certified that you are in compliance with the Americans with Disabilities Act (ADA).
PERSONAL INFORMATION NOTICE:
The New York State Gaming Commission needs personal information about you to make a decision on your license application. If you do not provide all or any part of the personal information requested, your application may be denied. The New York Lottery requires this personal information pursuant to its authority under Tax Law Section 1605 to license retailers to sell lottery tickets. Your personal information will be maintained by the Lottery’s Licensing Bureau. The manager of the Licensing Bureau is the custodian of such records and may be contacted by mail at P.O. Box 7500, Schenectady, New York 12301-7500.
I hereby acknowledge that I am authorized to represent the business applying for a New York Lottery Retailer License. I also acknowledge that I have read this application thoroughly, understanding that I may or may not be selected for a license, and that all of the information provided in this application is correct, to the best of my knowledge.
Legal Full Name (as you would sign):
Valid Email Address: