I am submitting this signed statement to Lee Enterprises, Incorporated, d/b/a the St. Louis Post-Dispatch (“Sponsor”) with the understanding that it will be relied upon in connection with the award of the prize of
Two tickets to John Legend, Sat. April 28, 8 p.m., Peabody Opera House
awarded from the Kevin C. Johnson John Legend Giveaway (the “Promotion”). The prize has an approximate retail value of $200.
1. I hereby affirm that I am a legal resident of the United States or its territories and possessions.
2.I further affirm that I am not now and was not at the time I entered the Promotion an employee of the St. Louis Post-Dispatch or Lee Enterprises, Incorporated, and that none of the members of my immediate family or other persons with whom I am domiciled are now or were, at the time I entered the Promotion, employees of the above newspaper or company. I further affirm that I have committed no fraud or deception in entering or participating in the Promotion and that I am at least 18 years of age. I agree to return immediately to the Sponsor any prize or value of such prize which has been or may be awarded to me if any statement made by me in this statement is false.
3.I hereby agree and understand that I am responsible for all federal, state, and local taxes that may be due and owing as a result of my winning. In the event I am unwilling or unable to pay such taxes, I hereby forfeit the Prize and waive any and all claims or interests I may have for the Prize. I understand and agree that I may receive a Form 1099, if applicable, at year end for the value of the prize. In addition, I may be asked to complete a W-9 along with this Statement of Eligibility & Release prior to receipt of the Prize for preparation of a 1099-MISC, if deemed appropriate per IRS 1099 rules.
4. I understand that Sponsor makes no representation about the suitability of the Prize for any purpose. The Prize is provided “as is” without warranty of any kind whether express or implied. All implied warranties, including, without limitation, implied warranties of merchantability and fitness for a particular purpose, are hereby expressly disclaimed. In no event shall Sponsor be liable to me, or any other person or business entity for any special, direct, indirect, punitive, incidental or consequential damages arising out of or in connection with the Prize.
I CERTIFY THAT I HAVE READ THIS STATEMENT OF ELIGIBILITY AND RELEASE AND THAT I FULLY UNDERSTAND ITS CONTENTS. I FURTHER CERTIFY THAT THE ABOVE ARE TRUE AND OF MY OWN PERSONAL KNOWLEDGE.