Certification of Winners - Commodity Games of Chance
NYS DEPARTMENT OF STATE
Division of Corporations, State Records and
Uniform Commercial Code
One Commerce Plaza, 99 Washington Avenue
Albany, NY 12231-0001
I certify that the persons whose names are shown below and on attached sheets have been awarded prizes in the amount or value shown and on date shown. This
contest is registered with the New York Secretary of State under Sponsor Name
, Name of Game
and File No.
DATE
NAME OF WINNER
DOS-0262-f-l (Rev. 07/11)
NAME
TITLE
ADDRESS (STREET, CITY, STATE, ZIP)
FIRM
DESCRIPTION OF PRIZE
AMOUNT OR VALUE
DATE PRIZE
DELIVERED