SPLIT-THE-POT
Date:
Game:
________________________________________________________________________
Social Security Number
________________________________________________________________________
Name
________________________________________________________________________
Permanent Address
________________________________________________________________________
City, State, Zip
________________________________________________________________________
Area Code
Telephone Number
CONGRATULATIONS! You have won approximately $_____________. The exact
amount will be determined by the final audit. A check will be mailed to you at the
address listed above. Please allow three weeks for processing.
Per IRS regulations The University of Montana must report any winnings of $600.00 or
more annually on IRS form W-2G. Payments of $5,000.00 or more require federal
income tax withholding on the entire amount at the 25% tax rate.
Thank you for participating in Grizzly, Split-The-Pot.
Jean Gee
Interim Athletic Director
SPLIT-THE –POT
PAYMENT VOUCHER
FOR BUSINESS SERVICES USE ONLY
Index
Revenue Account
Description
Activity Code
Staple Ticket
Drawn Here
________________________________
Departmental Approval
________________________________
Date
D:\291221017.doc
5/29/16
jmh
Amount___
Staple Winning
Ticket Here