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DC Office of Lottery & Gaming

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Signature HereClick to Sign
02/25/2024Click to Sign
02/25/2024
02/25/2024
Signature HereDepartment Representative Will Sign Here
02/25/2024
Signature HereInvestigators Will Sign Here

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Additional Signatures Required

Basic Business License* Click Here to Upload
Clean Hands Certificate* Click Here to Upload
Enterprise Release Form* Click Here to Upload
Operational, Surveillance, and Security Plan* (Required Only for Retailers) Click Here to Upload
Testing Lab Certification* (Required only for Distributor and Manufacturer Licenses) Click Here to Upload
ABRA Endorsement* (Required Only for Retailers) Click Here to Upload
Government Issued ID* Click Here to Upload
Government Issued ID cards for all other owners* (Required if more than one owner) Click Here to Upload
Key Personnel Release Form (if more than one owner - please sign and attach the form for all owners with 10% or more interest in the applicant) Click Here to Upload
Institutional Investor Certification Form (Attach one for each passive investor with 10% or more interest in the applicant) Click Here to Upload
Ownership and Corporate Structure of the Applicant* Click Here to Upload
Internal Controls* (Retailers and Distributors ONLY) Click Here to Upload