Terms you can choose
A voluntary lifetime self-ban. No removal process is published.
Lifetime is the only term this program offers.
When it ends
This has no published way to lift it.
How removal works. A voluntary lifetime self-ban. The Lottery publishes no removal process at all, so neither an end date nor a way off the list is on record.
On a lifetime term. Lifetime is the only term, and no removal process is published for it.
How to enroll
Mail the notarized agreement to the Responsible Gaming Coordinator.
Missouri Lottery, Attn: Responsible Gaming Coordinator, P.O. Box 1603, Jefferson City, MO 65102-1603. You can hand it in at any of the four Lottery offices instead. The Lottery adds your information on receipt but publishes no timeframe and no confirmation, so mailing the form does not tell you when the block is in place.
- Download the five-page agreement, or get one in person or by post from any Lottery regional office. We don't fill in or submit this form.
- Complete every field and sign in front of a notary. The agreement carries a Missouri notary acknowledgement with seal. No ID copy is requested; the notary's acknowledgement stands in for it.
- Mail the notarized agreement to Missouri Lottery, Attn: Responsible Gaming Coordinator, P.O. Box 1603, Jefferson City, MO 65102-1603, or deliver it to a Lottery office: Jefferson City, 1823 Southridge Drive; Independence, 3630 Arrowhead Avenue; Springfield, 1506 East Raynell; St. Louis, 1831 Craig Park Court.
- Keep a copy. No confirmation is published. The Lottery's number for the Responsible Gaming Coordinator is 573-751-4050 if you need to ask about your agreement.
Before you count on it. This is a lifetime agreement and no removal process is published. It does not stop ticket sales: you can still buy at any retailer, and prizes of $600 or less still pay. If you need to be kept out of casinos or sportsbooks, those are separate applications with the Gaming Commission. Whether non-residents may enroll, and whether an out-of-state or remote notary is accepted, are not verified. Mailing the agreement does not confirm enrollment.
Every route we checked
Routes that enroll you
- By mail — Missouri Lottery, Attn: Responsible Gaming Coordinator, P.O. Box 1603, Jefferson City, MO 65102-1603
The agreement directs the signed and notarized form to this address. This is an enrollment route, unlike the Gaming Commission's published address. - In person — any Missouri Lottery office: Jefferson City 1823 Southridge Drive; Independence 3630 Arrowhead Avenue; Springfield 1506 East Raynell; St. Louis 1831 Craig Park Court
The agreement permits the signed and notarized form to be otherwise delivered.
Routes that get you a form or an answer, not an exclusion
- By phone — 573-751-4050
Responsible Gaming Coordinator, published for reporting errant mailings. Not a submission route.
Requirements and sources
Sources read 2026-09-17. These are the program's requirements, not a record of anyone's enrollment.
- Terms available
- A voluntary lifetime self-ban. No removal process is published.
- Can a resident enroll
- Not verified: The agreement template refers to a city of residence in the State of Missouri, which is ambiguous, and no explicit residency rule is published. No reviewed source addresses residency eligibility.
- Can a visitor enroll
- Not verified: The agreement template refers to a city of residence in the State of Missouri, which is ambiguous, and no explicit residency rule is published. No reviewed source addresses residency eligibility.
- Identification
- Not verified: No identification copy is requested on the agreement; identity rests on the notary acknowledgement.
- Notarization
- Required. Forms must be completed in their entirety and notarized, and signed in the presence of a notary before being mailed or delivered.
- Witnesses
- Not verified: No separate witness requirement beyond the notary.
- Notarizing online
- Not verified: The agreement carries a Missouri notary acknowledgement block. Whether a remotely notarized or out-of-state notarized agreement is accepted is not addressed.
- How long processing takes
- Not verified: The Lottery adds the information on receipt but publishes no timeframe.
- How you are told it took effect
- Not verified: No confirmation mechanism is published.
The form asks for: name and city of residence, first, middle and last name, address, city, state and ZIP, telephone, gender, driver license number and issuing state, date of birth, Social Security number, email, player signature, notary acknowledgement with seal.
- Missouri Lottery problem gambling and self-exclusion molottery.com · read 2026-09-17
- Missouri Lottery self-exclusion from play and prize payment agreement molottery.com · read 2026-09-17