Eligibility for Award and Release_ Affidavit of by usman90


									                   Eligibility for Award and Release, Affidavit of
STATE OF ______________________
COUNTY OF ______________________

Name of winner: ________________________________________
Name of contest: ______________________________________
Date of winning: ________________________
Date of receipt of prize: ________________________
Enter description of prize: ______________________________________

The undersigned, ________________________________________, hereby being sworn to tell
the truth states:

   1. That they are the winner of the prize described above.

   2. That they were eligible under the rules and regulations of ____________.

   3. That they consent to use of their name, image and likeness by STATION.

   4. That their social security or taxpayer identification number is: _______________.

_________________________                         ______________________
Winner: Print Name & Address                      Driver’s License Number

                    Eligibility for Award and Release, Affidavit of
                                           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

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

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