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Lottery Pool Agreement

Date:

The undersigned agree that:

1. The period of this Lottery Pool Agreement ("Agreement") shall end exactly one year and one day from the latest drawing date that any lottery tickets are purchased for under this Agreement.

2. The following individuals ("Co-Owners") are participating in this Agreement, all of whom have contributed a total of for the purpose of purchasing entries into the contest drawing:

3. We each have an undivided interest in the tickets purchased and own the ticket(s) as tenants in common.

4. The tickets which are the subject of this Agreement consist of entries into the contest drawing to take place on . If no winner is selected on the original lottery date, this Agreement is valid until a winning jackpot ticket is selected.

5. No Co-Owner to this Agreement is under 18 years of age or otherwise prohibited by law from purchasing Lottery tickets or claiming a prize.

6. We agree to designate ("Manager"), who is a party to this Agreement, as the designated representative of all the Co-Owners to this Agreement, and he/she is authorized to act on our behalf. The Manager shall be responsible for collecting the funds for the lottery pool and use the funds to purchase lottery tickets. The Manager shall keep all tickets in a safe and secure place. The Manager shall serve without compensation for the entirety of this Agreement.

7. We recognize that the payment of lottery prizes is pursuant to state law and lottery regulations. Should the lottery tickets which are the subject of this Agreement result in a prize(s) for which lottery regulations permit direct payment, then a claim for direct payment shall be made. Where such regulations permit payment of the prize to only one natural person, then the Manager shall claim and hold the prize for the benefit of all Co-Owners.

8. The winnings will be distributed in

9. This Agreement constitutes the sole and entire agreement of the parties with respect to the subject matter of this Agreement, and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to the subject matter. This Agreement may only be altered in writing signed by all the Co-Owners.

10. Any Co-Owner may withdraw from the pool by written notice to the Manager at which time their membership in the pool thereupon ends, but remains in effect for any past drawings.

11. By signing this form, Co-Owners acknowledge that they have read and understood the above terms.