Affidavit of Eligibility

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									This form sets forth the necessary information for completing a contest, and releases
the party presenting the award from future liability. It serves as proof that the winner
received the prize, was eligible under the contest rules and consents to the use of his or
her photographs for promotional purposes. This document should be used by any entity
that holds contests where prizes are awarded.
               Affidavit of Eligibility for Award and Release
____________________________________________ [insert county and state]

Winner’s name and address: ____________________________________________
                              ____________________________________________
                              ____________________________________________
Contest name:
____________________________________________
Date of win:
____________________________________________
Date that prize was received:
 ____________________________________________
Description of prize:
____________________________________________


____________________________________________ [insert name of contest winner]
(“Winner”) affirms and agrees to the following:

    1. That Winner is eligible to win the prize under the rules of the contest, as set forth by
       ____________________________________________.

    2. That Winner consents to the use of whatever photographic likenesses or other
       promotional material may be reasonably necessary to further the efforts of
       _________________, provided that such likenesses of the Winner are approved by
       Winner prior to their use. Such approval shall not be unreasonably withheld.

    3. That the social security or taxpayer identification number of Winner is:
       _________________.


Signature of Winner:                __________________________________
Printed name of Winner:             __________________________________
Date:                               __________________________________



Witness:                            __________________________________
Date:                               __________________________________




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                        Affidavit of Eligibility for Award and Release
                                                    Review List

This review list is provided to inform you about this document in question and assist you in its
preparation. Contests are fraught with potential problems, conflicts of interest, and investigation
by government agencies. Use this document to keep a record of awards of any substantial size
to have a complete record should anyone or agency challenge the fairness or equity of the
contest.

1.    Make multiple copies.            Give one to the winner; keep the other in the Contest file.




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