Step 3 of 5: Owner Information
Owners: 2/10
Add all individuals with an ownership stake in this business. You may add up to 10 owners. All owners must have their identity documents uploaded in Step 4. Combined ownership must equal exactly 100%.
Total Ownership Claimed
75% / 100%
Remaining: 25% — Add more owners or adjust ownership percentages.
1
Owner 1 — John A. Smith
Primary
Background Disclosure Questions
Answer all questions. If you answer Yes to any question, attach a written explanation to be uploaded in Step 4.
| Question | Yes | No |
|---|---|---|
| Do you reside in the same household as any officer or employee of the Georgia Lottery Corporation? | ||
| Are you a vendor, employee, or agent of any vendor of the Georgia Lottery Corporation? | ||
| Have you been convicted of a criminal offense related to the security or integrity of the lottery in this or any other jurisdiction? | ||
| Have you been convicted of any illegal gambling activity, false statements, false swearing, or perjury, or any crime punishable by more than 1 year imprisonment or a fine of more than $1,000? | ||
| Are you delinquent in taxes, fees, or other obligations owed to the State of Georgia? | ||
| Have you filed for bankruptcy in the last 7 years? | ||
| Are you related to a COAM Class B Master Licensee? |
2
Owner 2 — Maria E. Johnson
Background Disclosure Questions
Answer all questions. If you answer Yes to any question, attach a written explanation to be uploaded in Step 4.
| Question | Yes | No |
|---|---|---|
| Do you reside in the same household as any officer or employee of the Georgia Lottery Corporation? | ||
| Are you a vendor, employee, or agent of any vendor of the Georgia Lottery Corporation? | ||
| Have you been convicted of a criminal offense related to the security or integrity of the lottery in this or any other jurisdiction? | ||
| Have you been convicted of any illegal gambling activity, false statements, false swearing, or perjury, or any crime punishable by more than 1 year imprisonment or a fine of more than $1,000? | ||
| Are you delinquent in taxes, fees, or other obligations owed to the State of Georgia? | ||
| Have you filed for bankruptcy in the last 7 years? | ||
| Are you related to a COAM Class B Master Licensee? |
Up to 10 owners per application