The Florida Lottery DOL 129 form serves as the official application for individuals or businesses seeking to become retailers for the Florida Lottery. This form collects essential information about the applicant's business and ownership structure, as well as details required for background checks. Completing this form accurately is crucial for a successful application process, so ensure all information is provided before submission.
To begin your application, please fill out the form by clicking the button below.
The Florida Lottery Dol 129 form serves as a crucial document for individuals and businesses looking to apply for a lottery retailer license in Florida. This application is intended for various scenarios, such as initial applications, changes in ownership, or adding new locations. The form requires applicants to provide essential information, including business details, contact information, and the names of individuals involved in the business. Additionally, a non-refundable application fee is required, with different amounts based on the type of application. Applicants must also undergo a background investigation, which may include fingerprinting, to ensure compliance with state regulations. Furthermore, the form includes sections that address the applicant's criminal history, ownership structure, and minority business status, among other considerations. Completing this form accurately is vital, as any misleading information can result in rejection or cancellation of the retailer contract. Overall, the Dol 129 form is a comprehensive application that outlines the necessary steps for becoming a licensed lottery retailer in Florida.
RETAILER APPLICATION
Florida Lottery
Retailer Contracting
250 Marriott Drive
Tallahassee, FL 32399-6573
(850) 487-7714 or floridalottery.com
FOR LOTTERY USE ONLY
ID# CHAIN#
PROSPECT#
DO
Non-refundable Application Fee: Payable to the Florida Lottery by check or money order.
Initial Application $100, Additional Location $25, Change of Location $10,
New Officer, Director or Shareholder $25 each.
Each applicant shall be subject to a background investigation which can include fingerprinting.
A retailer applicant shall be required to post a bond, certificate of deposit or other security if it is determined during the background
investigation that such requirement is necessary to secure payment of lottery proceeds.
Check application type and complete the information below – PLEASE PRINT OR TYPE:
INITIAL APPLICATION
100% SALE OF STOCK
ADDITIONAL STORE LOCATION
NEW OFFICER(S), DIRECTOR(S), SHAREHOLDER(S)
REMOVE OFFICER(S), DIRECTOR(S), SHAREHOLDER(S)
CHANGE OF LOCATION: Date of Relocation ________________________________
CHANGE OF OWNERSHIP: Previous Location ID# ____________________________ Date of Sale ___________________
For information concerning sale of business: Contact Name _____________________ Phone Number ( _______ ) _______– __________
SECTION 1 - BUSINESS INFORMATION
1.CORPORATE OR OTHER LEGAL NAME: _____________________________________________________________________
2.STORE NAME (dba): ___________________________________________ 3. STORE PHONE: ( ______ ) ______ – _________
4. STORE ADDRESS: _________________________________________________________________________________________
Street
City
State
Zip Code
County
5.MAILING ADDRESS: _______________________________________________________________________________________
Same as Store Address
Street or P.O. Box
6.CONTACT NAME AND TITLE: _______________________________________________________________________________
First
Middle Initial
Last
Title
7. CONTACT NUMBERS AND E-MAIL ADDRESS:
( ______ ) ______ – ______________
Mobile Phone
Alternate Phone
Fax Number
__________________________________________
Contact E-mail Address
Store E-mail Address
8.TAXPAYER IDENTIFICATION NUMBER: Provide number used to file business income tax return.
Sole Proprietors, list Social Security Number. All other entities, list Federal Employer Identification Number.
____ ____ _____ _____ _____ _____ _____ _____ _____
9. FLORIDA SALES TAX NUMBER: ___ ___ - ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ - ___ Applied For Tax Exempt
10. ALCOHOLIC BEVERAGE LICENSE NUMBER: ____ ____ -____ ____ ____ ____ ____
11. MINORITY BUSINESS:
YES
NO (If yes, check appropriate minority category)
Applied For
Not Applicable
__ African American
__ Native American
__ Hispanic American
__ American Woman
__ Asian American
12. BUSINESS TYPE: (Check One)
__ Partnership
__ Non Profit
__ Sole Proprietorship
__ Corporation
__ Limited Partnership
__ Limited Liability Company
__ Limited Liability Partnership
13. FLORIDA DEPT. OF STATE, DIVISION OF CORPORATIONS DOCUMENT NUMBER: ____________________________________
DOL-129 (Revised 5/24)
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SECTION 2 - OFFICER/OWNER INFORMATION
THE LOTTERY SHALL NOT CONTRACT WITH ANY PERSON WHO IS RELATED TO AND RESIDING WITH ANY EMPLOYEE OF THE LOTTERY.
1.LIST ALL OWNERS, INDIVIDUAL PARTNERS, MANAGING MEMBERS, CORPORATE OFFICERS, DIRECTORS.
LIST SHARE-HOLDERS OF 10% OR MORE OR LIMITED PARTNERS WITH 10% OR MORE INTEREST IN THE BUSINESS. IF MORE SPACE IS REQUIRED, PLEASE ATTACH ADDITIONAL SHEETS.
Name (first, middle initial, last)
Phone
Birthdate (MM-DD-YY)
Home Address
Zip
Sex
Race
% Ownership
Social Security Number
2.Are any of the individuals listed above related to an employee of the Florida Lottery in one of the following ways: husband, wife, parent, grandparent, spouse’s parent, child, brother, sister, spouse of a child, aunt, uncle, grandchild, niece, nephew, first cousin, and living in the same household as the employee? ____ Yes ____No
3. Have any of the individuals listed above:
a. Been convicted of, or pleaded guilty or nolo contendere to a felony within the last 10 years, regardless of adjudication?
b. Been convicted of, or pleaded guilty or nolo contendere to any gambling offense within the last 10 years, regardless of adjudication?
c. Been arrested and have any pending criminal charges that have not been resolved?
d.Been suspended or terminated as a Florida Lottery Retailer due to adverse findings?
e.Been subject to any adverse actions or findings as a lottery retailer with any other state lottery within the continental United States?
____ Yes ____No
If yes to questions a, b, c, d, or e, please explain response and include dates below (use additional sheet if necessary).
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4.For any individuals listed in the Ofcer/Owner Information, Section 2, who are not U.S. citizens, please list the individual’s name, mother’s maiden name, father’s name; passport number, permanent resident or I-94 number; the last permanent address prior to entering the U.S. and the last date of entry into the U.S.
How did you learn about becoming a Florida Lottery Retailer? Check one:
Florida Lottery Website
Word of Mouth
Direct Mail
Print Ad
Florida Business Information Portal
Other: Please Specify
Sales Rep Visit
Certification:
An attorney in fact may not make any affidavit as to the personal knowledge of the principal.
I HEREBY CERTIFY that the information contained on this form or otherwise submitted to the Florida Lottery in connection with my application to become a retailer is true and correct in every material respect. I understand that providing inaccurate or misleading information is grounds for rejection of this application or cancellation of the Retailer Contract. The Florida Lottery is authorized to obtain criminal background, Florida tax, credit, and general information about me, my business, and any persons listed on this application, which may assist in making a decision on this application. The business location where lottery tickets will be sold is in compliance with the accessibility requirements set forth in sections 553.501 - 553.513, Fla. Stat., the Florida Americans with Disabilities Accessibility Implementation Act.
I HEREBY CERTIFY I have read and understand the content contained in the Retailer Awareness and Integrity Training document found on the Florida Lottery’s website at floridalottery.com/business/retailers.
_________________________________________________________
State of _______________________________________
Signature of Authorized Corporate Officer, Partner, or Owner
County of _____________________________________
Sworn to or affirmed and subscribed before me this
Print or type name
__________________ day of ______________, ______,
(Day)
(Month)
(Year)
by ____________________________________________
(Name of Authorized Corporate Officer, Partner, or Owner)
______________________________________________
Signature of Notary Public
(Print, Type or Stamp Commissioned Name of Notary Public)
_____ Personally Known or _____ Produced Identification
Type of
Affix Notary stamp above.
Identification __________________________________
Certificates of Authority and retailer contracts are not assignable or transferable between persons or locations. STATEMENT OF PUBLIC DISCLOSURE: Information contained in this application shall be open to the public for inspection.
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MARKETING EVALUATION/SITE SURVEY
Store Name: _____________________________
1.TRADE STYLE (Circle One)
Airport Location
Convenience Store-
Hardware/Building Supplies
Restaurant - No Liquor
Appliances
no gas pumps
Hotel/Motel
Shopping Mall Location
Auto Parts/Repair
Ice Cream Shop
Small Grocery/Meat/Fish Market
Bakery
with gas pumps
Jewelry Store
Sports Arena/Amusement Park
Bar/Tavern/Lounge
Department Store
Laundry/Dry Cleaner
Supermarket
Barber Shop/Hairdresser
Dollar Store/Discount Store
Mail Services/Copy Center
Telecommunications Center
Beauty Shop
Drug Store/Pharmacy
Municipality/Political Subdivision
Travel Agency
Bingo Hall
Financial Services
Newsstand/Tobacconist/Sundries
Travel Plaza/Truck Stop
Bowling Alley
Flea Market
Non-Profit Organization
Wholesale Club
Car Wash
Florist
Package Liquor Store
Other _____________________
Clothing/Shoes
Gas Station/Auto Repair
Pari-Mutuel
Coffee/Deli/Sub Shop
Gift/Card Shop
Restaurant - Liquor
2. BUSINESS OPERATION:
SEASONAL BUSINESS
YEAR-ROUND BUSINESS
Business Hours
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
FROM …………
TO ……………..
3. RETAILER INSTALLATION INFORMATION:
New Construction or Store Not Yet Open? Please Check.
Yes
No
If yes, complete a, b, & c below.
a. Store opening date: __________________________
b. Approximate date for terminal and communications equipment installation: __________________________
c. Building contact name and phone number: _________________________________________________________
Retailer Owns Location? Please Check.
If no, complete a & b below.
Retailers with a lease agreement must have their landlord’s approval for the installation of communications equipment on the roof and the installation of cables inside the location.
a. Landlord contact name: ________________________________________________________________________________________
b. Landlord phone number:________________________________________________________________________________________
4. DISTRICT COMMENTS:
__________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
_______________________________________________________
___________________
Lottery Sales Representative or Designee Signature
SR#
Date
Lottery District Manager or Designee Signature
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NOTICES
RETAILER APPLICANTS
PRIVACY ACT NOTICE
Under the Federal Privacy Act, disclosure of a person’s Social Security number is voluntary unless a Federal statute specifically requires such disclosure or allows states to collect the number. In connection with filing an application to become a Florida Lottery retailer, disclosure of the applicant’s Social Security number is required by 26 U.S.C. s. 6109 for tax reporting purposes. The applicant’s Social Security number will also be used in performing the background investigation necessary to implement section 24.112, Florida Statutes, because the Social Security number is used as an identifier in the databases searched.
The Lottery may also provide this information to law enforcement agencies to enforce criminal laws.
Under subsection 119.071(5), Florida Statutes, an agency may collect Social Security numbers if it is imperative for the performance of the agency’s duties and responsibilities. Notice is hereby provided that for retailer applicants that are legal entities, it is imperative that the Lottery use the Social Security numbers of members, partners, officers, directors, etc., to conduct the background investigations necessary to implement section 24.112, Florida Statutes, because the Social Security number is used as an identifier in the databases searched.
NOTICE REGARDING TAXATION,
ORDINANCES, AND OCCUPATIONAL
LICENSES
Pursuant to subsection 24.122(2), Florida Statutes, no state or local tax shall be imposed upon any prize paid or payable under this act* or upon the sale of any lottery ticket pursuant to this act. Additionally, pursuant to subsection 24.122(3), Florida Statutes, all matters relating to the operation of the state lottery are preempted to the state, and no county, municipality, or other political subdivision of the state shall enact any ordinance relating to the operation of the lottery authorized by this act. However, this subsection shall not prohibit a political subdivision of the state from requiring a retailer to obtain an occupational license for any business unrelated to the sale of lottery tickets.
*The act refers to Florida Statutes, Chapter 24 ("Florida Public Education Lottery Act")
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Filling out the Florida Lottery Dol 129 form is an important step for those looking to become a retailer for lottery products. This form requires detailed information about your business and its owners. After completing the form, it will be submitted to the Florida Lottery for processing. Ensure that all information is accurate and complete, as this will help streamline the application process.
The Florida Lottery DOL 129 form serves as an application for individuals or businesses wishing to become authorized retailers of lottery products in Florida. This form collects essential information about the applicant, including business details, ownership structure, and compliance with legal requirements. It is a necessary step for any entity aiming to sell lottery tickets and participate in the Florida Lottery system.
Applicants must pay a non-refundable application fee when submitting the DOL 129 form. The fees are as follows:
These fees must be paid via check or money order made out to the Florida Lottery.
All applicants are subject to a background investigation, which may include fingerprinting. This investigation aims to ensure that individuals associated with the business meet the integrity standards required by the Florida Lottery. If deemed necessary, applicants may also be required to post a bond or other security to secure payment of lottery proceeds.
The business section of the DOL 129 form requires detailed information about the applicant's business, including:
This information helps the Florida Lottery assess the applicant's eligibility and compliance with state regulations.
Yes, there are specific restrictions in place. The Florida Lottery will not contract with any person who is related to and resides with an employee of the Florida Lottery. Additionally, individuals with certain criminal backgrounds, including felony convictions or unresolved criminal charges, may be disqualified from becoming a retailer.
The information submitted on the DOL 129 form is subject to public disclosure under Florida law. However, personal information, such as Social Security numbers, is collected under the Federal Privacy Act for specific purposes, including tax reporting and background investigations. The Florida Lottery is required to protect this information and may share it with law enforcement agencies as necessary to enforce criminal laws.
Filling out the Florida Lottery DOL 129 form can be a straightforward process, but many applicants make common mistakes that can lead to delays or rejections. One frequent error is failing to provide a complete Florida Lottery ID number. This number is crucial for processing the application. Without it, the form may be considered incomplete, causing unnecessary setbacks.
Another mistake is neglecting to pay the non-refundable application fee. Applicants often forget to include a check or money order for the required amount. This oversight can halt the application process entirely. It’s essential to double-check that the payment is included and correctly filled out.
Many applicants also struggle with the business information section. Inaccurate or incomplete entries, such as incorrect addresses or missing contact details, can lead to confusion. Ensure that all information is accurate and clearly printed to avoid any issues.
Providing the wrong taxpayer identification number is another common pitfall. Sole proprietors should list their Social Security number, while other entities must provide their Federal Employer Identification Number. Misidentifying these numbers can lead to complications with tax reporting and background checks.
Some applicants fail to answer questions about ownership and affiliations fully. The form requires detailed information about all owners, partners, and corporate officers. Missing this information can raise red flags during the background investigation, potentially resulting in application denial.
Additionally, not disclosing any felony convictions or pending criminal charges can be detrimental. Honesty is crucial, as failing to provide this information can lead to immediate rejection of the application. Transparency helps build trust with the Florida Lottery.
Many people overlook the importance of checking the box for minority business status. This section can impact eligibility for certain programs and incentives. If applicable, be sure to mark this accurately to take advantage of potential benefits.
Lastly, applicants often forget to sign and date the certification section. This signature is a vital part of the application, affirming that the information provided is accurate. An unsigned form will not be processed, leading to further delays.
By avoiding these common mistakes, applicants can streamline the process and increase their chances of becoming a Florida Lottery retailer. Careful attention to detail is essential when completing the DOL 129 form.
The Florida Lottery Dol 129 form is a crucial document for individuals or businesses seeking to become lottery retailers in Florida. Along with this form, several other documents may be required or helpful during the application process. Below is a list of additional forms and documents often associated with the Dol 129 form.
These documents collectively support the application process for becoming a Florida Lottery retailer. Ensuring that all necessary forms are completed accurately can facilitate a smoother application experience.
The Florida Lottery Dol 129 form shares similarities with the business license application. Both documents require detailed information about the business, including ownership structure and the nature of operations. Just as the Dol 129 form collects data on the owners and their backgrounds, a business license application often asks for the same kind of personal information to ensure that the individuals involved meet local regulations. Additionally, both applications usually entail a fee and may involve a background check to confirm the integrity of the applicants.
Another document similar to the Dol 129 form is the state sales tax registration form. This form is essential for businesses that sell taxable goods and services. Like the Dol 129, it requires the business's legal name, address, and taxpayer identification number. Both forms also emphasize the importance of compliance with state regulations, as the sales tax registration is necessary for legal operation within the state. Failure to submit accurate information on either form can lead to penalties or rejection of the application.
The liquor license application is another document that parallels the Dol 129 form. Both forms require applicants to disclose information about the business and its owners, including any criminal history that could affect eligibility. The liquor license application, much like the Dol 129, may also require a fee and a thorough background investigation. Ensuring that the business operates within legal guidelines is a common thread between these two applications.
Additionally, the permit application for operating a food establishment shares similarities with the Dol 129 form. Both documents require detailed business information, including ownership details and the nature of the business. They also often require compliance with health and safety regulations. Just as the Dol 129 form may require a background check, food establishment permits also often necessitate inspections and adherence to local health codes before approval.
Finally, the contractor's license application can be compared to the Dol 129 form. Both documents necessitate comprehensive information about the business and its owners, including financial disclosures and any relevant criminal history. The contractor's license application, similar to the Dol 129, aims to ensure that individuals operating within these fields meet specific qualifications and standards set by the state. Both processes also typically involve a fee and may require proof of insurance or bonding to protect consumers.
When filling out the Florida Lottery DOL 129 form, it's important to follow certain guidelines to ensure a smooth application process. Below is a list of things you should and shouldn't do:
Following these guidelines can help ensure that your application is processed efficiently and without unnecessary delays.
Misconception 1: The DOL 129 form is only for new lottery retailers.
This form is applicable not just for new retailers but also for existing retailers who need to make changes, such as adding a new location or changing ownership. It serves multiple purposes in the lottery retailer application process.
Misconception 2: The application fee is the only cost involved.
While there is a non-refundable application fee, additional costs may arise. These include fees for changes in location, new officers, or other modifications to the business structure, which can add to the overall expense of becoming a retailer.
Misconception 3: Background checks are optional for all applicants.
Background checks are mandatory for all applicants. This process may include fingerprinting and is essential for determining eligibility to sell lottery products. Failing to comply with this requirement can lead to application rejection.
Misconception 4: The information provided in the application is confidential.
Contrary to this belief, the information in the DOL 129 form is subject to public disclosure. This means that it can be inspected by the public, which emphasizes the importance of providing accurate and truthful information.
Here are key takeaways regarding the Florida Lottery DOL 129 form:
Fill in Your Florida Lottery Dol 129 Form