Drawing will be held March 1, 2014 after 10 p.m. at the Borgata Hotel, Casino
and Spa. Winner need not be present to win. Winner will receive 50% of the ...
Ticket Purchase Form
Super 50/50 Raffle (NJLGCC # 4190)
Proceeds Benefit Virtua’s Patient Care Fund
Cost:$100 per ticket (Only 1,000 tickets can be sold) Last year’s winning ticket was worth $34,500! Anyone can purchase tickets, including your friends and family. Drawing will be held March 1, 2014 after 10 p.m. at the Borgata Hotel, Casino and Spa. Winner need not be present to win. Winner will receive 50% of the proceeds. Note: If purchasing as a group, all first and last names of participants must be listed.
Please make checks payable to: Virtua Foundation Name/Company:_________________________________ Please send me _____ ticket(s) at $100 per chance. Contact Person:__________________________________ Enclosed amount:__________________________ Address:________________________________________ Please charge my account: City:___________________________________________
Amex ___ Visa___ MasterCard___ Discover ___
State:_________________________ Zip:______________
Account #:______________________________
Phone:_________________________________________
Expiration Date:___________ CSV__________
Fax:___________________________________________
Signature:______________________________
Preferred E-mail:_________________________________________ Pursuant to IRS rules and regulations the proceeds due the winner of the 50/50 prize will be subject to federal withholding tax of 24% and state withholding tax of 3%. Persons under the age of 18 are not permitted to participate in this game of chance. (N.J.S.A. 5:8-5:9) Virtua Foundation, 50 Lake Center, 401 Route 73 N., Suite 301, Marlton, NJ 08053 Phone 856.355.0830 Fax 856.355.0831
For additional event details, please contact Virtua Foundation at 856.355.0830 or
[email protected].
