Free Certification by Raffle Winner Office of the Secretary of State, State House, Annapolis MD 21401 - Maryland

Certification by Raffle Winner
Office of the Secretary of State, State House, Annapolis MD 21401 Telephone: (410) 974-5534 or (800) 825-4510

This section is to be completed by the raffle winner and is to be retained on file by the charitable organization for a period of 3 years after the selection of the raffle winner. Date

I,__________________________________, having been selected the winner of the raffle described herein, do hereby certify that I have read and understand the contents of the disclosure statement. Signature of Raffle Winner Printed or Typed Name of Raffle Winner Address of Raffle Winner Signature of Witness