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It sounds like a custom form for manually wheeling numbers.
We did not make such forms, as they are not needed with the Lottery Director software. Other folks did make them, however, distributing them to players.
If you have the Lottery Director software, here is how to find the wheel.
Start your software, and go to any Pick-5 game.
... On your game's MAIN screen, go to your PICK menu.
... On your PICK menu, select: 'Wheeling Systems'.
... You'll see your list of wheels.
Scroll down through the wheels. You'll find the wheel you mentioned.
... It's wheel 135.
"Key1" wheel (uses 1 Key number).
Takes 9 numbers. Makes 15 combinations.
If you match the Key number and any 3 of the other numbers, you'll have a 4-number prize.
Instead of wheeling your numbers manually, you can do it automatically in the software.
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Feel free to explore this further, if you like. We are happy to help with it.
Lottery Director Support