Shafer 2013.08.29 On August 28th, 2013 I was notified by Jean Adler, Lottery Deputy Administrator, to look into the possibility of a stolen ticket complaint from the player point of view (not initiated from either a retailer or from GTECH). -Gathered and took possession of the original validation file (Winner Claim documents) for the instant ticket in question from Sue McKinney, lottery validations. Items: (Exhibit A, 1-9) File Contains PERSONALLY IDENTIFIABLE INFORMATION, SSN redacted Winner Claim Documents 1) 2) 3) 4) 5) 6) 7) 8) 9) Copy of the WI Lottery Administrative Check form Assigned No.6200515 Copy of check no. 36241526 $1,448.71 Copy of the WI Lottery Administrative Check form Assigned No.6200514 Copy of check no. 36241525 $5,281.29 Copy of front/back of Actual instant ticket for game no. 372, 20X The Money, Copy of front /back of the original WI Lottery Winner Claim Form No. 069948 Copy of the original WI Lottery Winner Claim Form No. 069948 (front only) Copy of the WI Lottery Notice of Deductions From Prize Winnings form Copy of the GenTax WPF printout- indicating the amount to deduct for offset, $1,448.71 -Obtained the Winner photo (Exhibit B, is a b&w copy) from the Winner's board in Validations (this is the only copy of the photo, the electronic photo has been deleted from the flash card. -Incident was discussed with Jean Adler, Colleen Dvorak, John Sams and Chris Heitmann. See John Sams statement paragraph 4, (Exhibit H) -Pulled GWARE Report listing transactions for Game 372 ticket number 024: (Excel Spreadsheet) (Exhibit C) No Date Time Agent Id Name Address City Zip Game # Pack # Ticket # Amount Result Trans. Type 1 8/13/2013 14:17:39 192313 MEGA WEST 2615 N CLAIREMONT AVE EAU CLAIRE 54703 372 111006 24 $10,000.00 #IVAL_APP_NORMAL GOOD CASH 2 8/15/2013 11:43:38 199869 FOSTER CENEX CONVENIENCE STORE E10914 CTY RD HH 372 111006 24 $10,000.00 #IVAL_APP_NORMAL GOOD CASH 3 8/15/2013 14:26:04 1 CLAIMS & PAYMENTS - REDEMPTION CENTER OSSEO 54758 372 111006 24 $10,000.00 #IVAL_APP_NORMAL GOOD CASH 4 8/15/2013 14:28:38 1 CLAIMS & PAYMENTS - REDEMPTION CENTER 372 111006 24 $10,000.00 #IVAL_APP_NORMAL GOOD CASH _ Exhibit C - line 1 shows when Mr. Lau presents his winning instant ticket at Mega West. The result code indicates the instant ticket must be presented to Lottery for payment. (Value exceeds $600.00) Line 2 shows the same instant ticket being presenting at Foster Cenex convenience store in Osseo two days. The result code indicates the ticket must be presented to Lottery for payment. Lines 3 and 4 show the instant ticket being presented at the WI Lottery Madison redemption center for payment. -Received Faxed documents from John Sams that were sent to him by Mr. John Lau Items: (Exhibit D, 1-3) File Contains PERSONALLY IDENTIFIABLE INFORMATION, SSN redacted 1) Faxed copy of the WI Lottery Winner Claim Form No. 029700 (Old form filled out at the store- Mega West) 2) Faxed copy of instant ticket (front side only) for game no. 372, 20X The Money, 3) Faxed copy of the USPO Certified Mail Receipt, No. 7012 1010 0002 5597 5595, dated August 13, 2013. I have included a copy of the fax Journal Report for August 28, 2013, the day Mr. Lau sent the Lottery the information. (Exhibit E) -Surveillance video initially pulled on August 28, 2013. However, original and additional video and still images were pulled on August 29, 2013 that are presented on the CD-R disk labeled Shafer 2013.08.15 (Exhibit F) and dated 2013.08.29. Date stamp is correct, however the timestamp may be slightly off (by a minute of two) due to time server sync differences. Items: Directory: 20130815-Shafer Subdirectories: Validation Door -video (4) and stills (3) Validation Window –video (5) and stills (5) -Photo printouts (Exhibit G, 1-8) these are also on Exhibit F disk. (Still images contain server name and IP address) 1) Shafer-Pic1 Lottery Validation Window- shows Shafer in the white T-shirt and his brother Justin Brummond. 2) Shafer-Pic2 Lottery Validation Window- is a close up of Shafer-Pic1, Shafer and his brother Justin Brummond who is wearing the ball cap. 3) Shafer-Pic3 Lottery Validation Window-, Shafer holding copy of winning ticket check image 4) Shafer-Pic4 Lottery Validation Window- shows Shafer signing WI Lottery Winner Claim Form and his brother Justin Brummond in theball cap. 5) Shafer-Pic5 Lottery Validation Window- MISC, Shafer and his brother Justin Brummond 6) Shafer-Pic6 Lottery Validation Door- shows Shafer and his brother, Justin Brummond, walking in to DOR to start the WI Lottery Winner claim process. 7) Shafer-Pic7 Lottery Validation Door- shows a person of interest that Shafer's brother, Justin Brummond, is talking too. We do not know if this individual is with Shafer. Video indicates they may be together. 8) Shafer-Pic8 Lottery Validation Door- shows the person of interest talking with Shafer's brother, Justin Brummond, as all three are walking out together. -John Sams submitted his accounting of his interaction with this incident. (Exhibit H) -On August 28, 2013, Jean Adler and Chris Heitmann contact Mega West and Foster Cenex convenience store to speak with manager or store security to see if we can get a copy of their surveillance video for the dates and times in question. -On August 28, 2013 Late afternoon-notified Lottery director Michael Edmonds along with Jean Adler of the incident and gave status update -On August 29, 2013 2:41 PM Chris Heitmann calls Siri Andrus of Foster Cenex convenience store to ask for surveillance video. Store clerk said Siri had left for the day. I left my name and number for Siri to return my call upon her return to the store. -(Exhibit I) Jean Adler's summary -(Exhibit J) Additional info from John Sams -Face Book search results (Exhibit K, 1-2) Items: 1) Justin Brummond, brother of James Shafer-see link to James Shafer under Family section of Face Book post. a. Note profile photo of Justin Brummond and his girlfriend Kimberly Ann Strand. See Mega West video still images, Kimberly Ann Strand looks like the clerk in the dark colored shirt behind the counter. b. Note JADE excavation & trucking LLC- could there be a link between this employer and the person if interest in images G7 and G8? 2) James Shafer, brother of Justin Brummond- see Family section of Face Book post.