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The Florida Lottery Dol 129 form serves as a crucial document for individuals and businesses seeking to become authorized retailers of lottery products in the state. This application form requires detailed information about the applicant, including business structure, ownership, and compliance with legal requirements. Applicants must pay a non-refundable fee that varies based on the type of application, such as initial applications, changes in location, or updates to ownership. A thorough background investigation is mandatory, which may include fingerprinting, to ensure the integrity of the lottery system. Additionally, applicants may need to provide security measures, such as a bond or certificate of deposit, depending on the findings of the background check. The form also collects essential data on the business, including tax identification numbers and contact information, while ensuring compliance with accessibility standards. The application process emphasizes transparency, as the information submitted is subject to public disclosure. Overall, the Dol 129 form is designed to facilitate the careful selection of lottery retailers, safeguarding the interests of both the Florida Lottery and the community it serves.

Documents used along the form

When applying to become a Florida Lottery retailer, several other forms and documents may be required alongside the Florida Lottery DOL 129 form. These documents help ensure that the application process is thorough and that all necessary information is collected for evaluation. Below is a list of common forms and documents that often accompany the DOL 129.

  • Background Check Authorization Form: This document authorizes the Florida Lottery to conduct a background check on the applicant. It typically includes personal information such as social security number and consent for the lottery to access criminal history.
  • Retailer Agreement: This is a contract that outlines the terms and conditions between the Florida Lottery and the retailer. It specifies the rights and responsibilities of both parties regarding the sale of lottery tickets.
  • Bond or Security Document: Depending on the results of the background check, a bond or other form of security may be required. This document serves as a guarantee for the payment of lottery proceeds and is typically issued by a financial institution.
  • Tax Exemption Certificate: If applicable, this certificate verifies that the retailer is exempt from certain taxes. It may be required for businesses claiming tax-exempt status under Florida law.
  • Lease Agreement: If the retailer does not own the location where lottery tickets will be sold, a lease agreement must be submitted. This document provides proof of the right to operate a business in that location.
  • Certificate of Incorporation or Business Registration: This document proves that the business is legally registered in Florida. It is essential for corporations and limited liability companies to demonstrate their legal standing.
  • Minority Business Certification (if applicable): If the applicant qualifies as a minority-owned business, this certification verifies their status and may provide additional benefits in the application process.

Having these documents ready can streamline the application process and help ensure compliance with all requirements. Being organized and thorough will facilitate a smoother experience when applying to become a Florida Lottery retailer.

Similar forms

The Florida Lottery Dol 129 form is akin to a business license application. Both documents require detailed information about the business, including ownership structure, location, and operational details. Just like a business license application, the Dol 129 form ensures that the applicant meets specific regulatory requirements before being allowed to operate. Additionally, both forms often necessitate a fee and may involve a background check to verify the integrity of the business owners, ensuring compliance with state laws.

Another document similar to the Dol 129 is the state sales tax registration form. This form collects information about a business's sales tax obligations, including the business name, address, and taxpayer identification number. Much like the Dol 129, it requires applicants to provide details about the ownership structure and may involve a verification process. Both forms are essential for ensuring that businesses operate within the legal framework set by state authorities.

The application for an alcoholic beverage license also shares similarities with the Dol 129. Both documents require applicants to disclose information about the business owners and their backgrounds. Just as the Dol 129 assesses the suitability of lottery retailers, the alcoholic beverage license application evaluates whether the applicants meet the criteria for selling alcohol. Each application serves to uphold public safety and compliance with state regulations.

In addition, the Florida Department of State's corporate registration form is comparable to the Dol 129. This form requires businesses to register their legal entity status, providing essential details about ownership and management. Like the Dol 129, it necessitates accurate information to ensure that the business complies with state regulations. Both documents are crucial for establishing a legal presence in Florida.

The federal Employer Identification Number (EIN) application is another document that bears resemblance to the Dol 129. Both forms require information about the business structure and ownership. The EIN application is necessary for tax purposes, while the Dol 129 is essential for lottery operations. Both processes ensure that the business is recognized by the government and can operate legally within its respective framework.

The application for a business bank account is also similar to the Dol 129. When opening a business bank account, owners must provide documentation about the business structure, ownership, and identification. This is akin to the information required in the Dol 129. Both applications aim to establish legitimacy and ensure that the business complies with financial regulations.

Furthermore, the application for a commercial lease can be compared to the Dol 129. Both documents require detailed information about the business, including ownership and operational plans. When applying for a commercial lease, landlords often need to conduct background checks, similar to the background investigation process outlined in the Dol 129. Both applications aim to protect the interests of all parties involved.

Lastly, the vendor registration form for government contracts is akin to the Dol 129. Both forms require businesses to provide detailed information about their ownership and operational structure. The vendor registration form ensures that businesses are eligible to bid on government contracts, much like the Dol 129 ensures that lottery retailers meet specific criteria. Both processes serve to uphold standards and accountability in business operations.

Obtain Answers on Florida Lottery Dol 129

  1. What is the Florida Lottery DOL 129 form?

    The Florida Lottery DOL 129 form is an application used by businesses seeking to become authorized retailers of lottery tickets in Florida. This form collects essential information about the business, its owners, and any relevant background details necessary for the Florida Lottery to evaluate the application. It is crucial for ensuring compliance with state regulations and for maintaining the integrity of the lottery system.

  2. What fees are associated with submitting the DOL 129 form?

    When submitting the DOL 129 form, applicants must pay a non-refundable application fee. The fees are structured as follows:

    • Initial Application: $100
    • Additional Location: $25
    • Change of Location: $10
    • New Officer, Director, or Shareholder: $25 each

    Payment should be made by check or money order payable to the Florida Lottery. It’s important to note that all applicants are subject to a background investigation, which may include fingerprinting, and may also require posting a bond or other security based on the results of that investigation.

  3. What information is required on the DOL 129 form?

    The DOL 129 form requires detailed information about the business and its owners. Key sections include:

    • Business information such as the legal name, store name, address, and contact details.
    • Taxpayer identification numbers, including Social Security Numbers for sole proprietors or Federal Employer Identification Numbers for other entities.
    • Information about the owners and corporate officers, including their background, ownership percentage, and any criminal history.

    Completing this form accurately is essential, as any misleading information can lead to rejection of the application or cancellation of the retailer contract.

  4. How does the background investigation process work?

    Once the DOL 129 form is submitted, the Florida Lottery conducts a thorough background investigation. This process may involve checking criminal history, tax compliance, and other relevant information about the business and its owners. Applicants must be aware that:

    • The investigation can include fingerprinting.
    • Any felony convictions or gambling offenses within the last ten years must be disclosed.
    • Individuals related to current Florida Lottery employees may be disqualified from becoming retailers.

    This investigation ensures that only qualified and trustworthy individuals are allowed to sell lottery tickets, thereby protecting the integrity of the lottery system.

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RETAILER APPLICATION

FOR LOTTERY USE ONLY

Florida Lottery

ID#___ CHAIN#___

250 Marriott Drive

PROSPECT#______

Tallahassee, FL 32399-6573

(850) 487-7714 or flalottery.com

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:

0 INITIAL APPLICATION O100% SALE OF STOCK O NEW OFFICER(S), DIRECTOR(S), SHAREHOLDER(S) 0 ADDITIONAL STORE LOCATION

0 CHANGE OF LOCATION: Date of Relocation ____________

0 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: _______________________________

StreetCityState Zip Code County

 

 

 

_

5. MAILING ADDRESS: _____________________________

SameasStoreAddressO Street or P.O. Box

City

State

Zip Code

6. CONTACT NAME AND TITLE: ___________________________

First

Middle Initial

Last

Title

7. CONTACT NUMBERS AND E-MAIL ADDRESS:

 

{ __} __-____

{ __} __-____

{ __} __- ____

Phone

Alternate Phone

 

Fax Number

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: _ _ - _ _ _ _ _ _ _ _ _ _ - _ 0 Applied For O Tax Exempt

10. ALCOHOLIC BEVERAGE LICENSE NUMBER: __-_____

0 Applied For O Not Applicable

11.

MINORITY BUSINESS: 0 YES

ONO (If yes, check appropriate minority category)

 

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 4/19)

1

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.Are any of the individuals listed below 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

2.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

 

Title

 

 

Birthdate (MM-DD-YY)

Home Address

City

State

Zip

Sex

Race

% Ownership

Social Security Number

Name (first, middle initial, last)

 

Phone

 

Title

 

 

Birthdate (MM-DD-YY)

Home Address

City

State

Zip

Sex

Race

% Ownership

Social Security Number

Name {first, middle initial, last)

 

Phone

 

Title

 

 

Birthdate (MM-DD-YY)

Home Address

City

State

Zip

Sex

Race

% Ownership

Social Security Number

Name {first, middle initial, last)

 

Phone

 

Title

 

 

Birthdate (MM-DD-YY)

Home Address

City

State

Zip

Sex

Race

% Ownership

Social Security Number

Name (first, middle initial, last)

 

Phone

 

Title

 

 

Birthdate (MM-DD-YY)

Home Address

City

State

Zip

Sex

Race

% Ownership

Social Security Number

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?

Yes No

Yes No

c. Been arrested and have any pending criminal charges that have not been resolved?

Yes

No

d. Been a Florida Lottery Retailer?

Yes

No

e. Been suspended or terminated as a Florida Lottery Retailer?

Yes

No

f. 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, e, or f, please explain response and include dates below (use additional sheet if necessary).

DOL-129 (Revised 4/19)

2

4.For any individuals listed in the Officer/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 1-94 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:

D Sales Rep Visit

D Florida Lottery Website

D Word of Mouth

D Direct Mail

D Print Ad

D Florida Business Information Portal

D Other: Please Specify

 

 

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 flalottery.com/HowToApply.

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)

 

 

Title

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.

DOL-129 (Revised 4/19)

3

MARKETING EVALUATION/SITE SURVEY

Store Name: ---------------- COMPLETE WITH LOTTERY SALES REPRESENTATIVE

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

Convenience Store-

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:

0 SEASONAL BUSINESS

0 YEAR-ROUND BUSINESS

 

Business Hours

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

SUNDAY

FROM

 

 

 

 

 

 

 

TO

 

 

 

 

 

 

 

3. RETAILER INSTALLATION INFORMATION:

Yes

No

New Construction or Store Not Yet Open? Please Check.

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.

Yes

No

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.COMMENTS:

Sales Representative: -----------------------------------

 

 

 

 

 

 

 

 

 

 

Lottery Sales Representative Signature

SR#

Stop#

Date

Lottery District Manager:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lottery District Manager Signature

Date

4

DOL-129 (Revised 4/19)

PRIVACY ACT NOTICE

RETAILER APPLICANTS

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 Securtiy number is required by 26 U.S.C.A. 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 Section 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.

5

DOL-129 (Revised 4/19)

Dos and Don'ts

When filling out the Florida Lottery Dol 129 form, it is important to adhere to certain guidelines to ensure a smooth application process. Here are six things you should and shouldn't do:

  • Do: Provide accurate and complete information in all sections of the form.
  • Do: Ensure that you check the correct application type before proceeding with the form.
  • Do: Include the non-refundable application fee as specified in the instructions.
  • Do: List all owners and key individuals associated with the business accurately, including their contact information.
  • Don't: Leave any required fields blank; all sections must be filled out to avoid delays.
  • Don't: Provide misleading or false information, as this could lead to rejection of your application.

By following these guidelines, you can help ensure that your application is processed efficiently and effectively. Attention to detail is crucial in this process.