Hornsby et al v. Macon County Greyhound Park, Inc.

Filing 193

MEMORANDUM OPINION AND ORDER directing that the 188 Joint Motion for Preliminary Approval of Settlement Agreement, including certification of a settlement class, approval of a notice plan, and setting of a fairness hearing scheduled to be held bef ore the court on April 22, 2013 at 10:00 a.m. at the United States Courthouse, Frank M. Johnson, Jr. U.S. Courthouse Complex, One Church Street, Montgomery, Alabama 36104 is GRANTED, as further set out. Signed by Honorable Judge Myron H. Thompson on 1/16/13. (Furnished to Calendar/AG) (Attachments: # 1 NOTICE OF CLASS ACTION AND PROPOSED SETTLEMENT, # 2 CLASS NOTICE OPTION SELECTION CLAIM FORM, # 3 Envelope cover, # 4 Release)(scn, )

CLASS NOTICE OPTION SELECTION CLAIM FORM
*IMPORTANT*
You Must Select ONE Of the Four Options and Follow the Instructions Below. Failure to
do so may result in your forfeiting your rights. CHOOSE ONLY ONE

OPTION 1
Acceptance of Settlement -- I choose to participate as a settlement class member and receive the
approximate $1,331.45 settlement benefit. By signing below, I affirm that I am a former employee of Macon
County Greyhound Park, Inc. who was permanently laid off in January or February 2010 and that I was
covered by the Macon County Greyhound Park, Inc.’s Blue Cross and Blue Shield group health insurance
plan. I affirm my belief that I did not receive adequate COBRA/ARRA notification following my layoff and
that I was not rehired by Macon County Greyhound Park, Inc., following my layoff. I understand that if the
above statements are true and I wish to participate in the class action settlement, I must provide the requested
information and return this Claim Form to First Class, Inc., 5410 West Roosevelt Road, Suite 222, Chicago,
Illinois 60644-1479. If the settlement is approved by the Court, I will receive a payment in the amount of
approximately $1,331.45.  (This amount could change slightly based upon the incorrect inclusion or omission
of possible class members.)

I swear and affirm that I am not currently in bankruptcy and that I understand that I am responsible
for payment of any and all taxes from the class action settlement.

______________________________________

______________________________________
Name – PLEASE PRINT

Name – SIGNATURE

Date of Birth: _________________________

Social Security No.: ______________________

CURRENT ADDRESS:
_____________________________________
Street Address

CURRENT TELEPHONE(S):
Home: _________________________________

Work: ________________________________
_____________________________________
Post Office Box # (if applicable)
_____________________________________
City
State
Zip

Cell: __________________________________
Email Address:
________________________________________

If you choose Option 1, please print and sign your name and provide your telephone number. Return this
form in the pre-addressed, stamped envelope provided for your convenience. You need not take any further
action.

OPTION 2

CLASS NOTICE OPTION SELECTION CLAIM FORM
*IMPORTANT*
You Must Select ONE Of the Four Options and Follow the Instructions Below. Failure to
do so may result in your forfeiting your rights. CHOOSE ONLY ONE
(Do not participate) - I do NOT wish to participate in this lawsuit against Macon County Greyhound Park
(“VictoryLand”). By selecting this option, I understand that I am waiving my rights to bring any future action
as described in detail in the TERMS OF RELEASE. I also understand that I am waiving (giving up) my claim
to the $1,331.45 settlement benefit that is being held in trust to be paid to settlement class members. I
understand that after making this selection I cannot come back later and select another option.
Print Your Name: _________________________ Your Signature: __________________________
Your Telephone Number: _____________________
If you choose Option 2, please print and sign your name and provide your telephone number. Return this
form in the pre-addressed, stamped envelope provided for your convenience. You need not take any further
action.

           OPTION 3
(Bring your own Lawsuit) - I do NOT wish to participate in this lawsuit against Macon County Greyhound
Park (“VictoryLand”) and thereby waive all present and future claims to the settlement benefit amount of
$1,331.45. By selecting this option I certify that I have special damages in excess of the settlement claim
amount of $1,331.45 and I intend to bring my own lawsuit. (In order to choose this option you must have
special damages in excess of the settlement claim amount.). This letter must be postmarked no later than(45
days from the date of mailing). Furthermore, I understand that I will be responsible for retaining my own
Attorney and all Attorneys’ fees, costs, and expenses in prosecuting my personal action will be at my personal
expense and that the Attorneys appointed by the Court (Class Counsel) will not be representing me or
assisting me in the prosecution of my case. I understand that it will be my responsibility to prove liability,
that there has been no judicial determination of liability, VictoryLand denies liability, and if I am unable to
prove liability in the appropriate Court of Law there no award for damages, including special damages that
I may have incurred.
Print Your Name: _________________________ Your Signature: __________________________
Your Telephone Number: _____________________
If you choose Option 3, please print and sign your name and provide your telephone number. Return this
form in the pre-addressed, stamped envelope provided for your convenience postmarked no later than(45
days from the date of mailing).

OPTION 4

2

CLASS NOTICE OPTION SELECTION CLAIM FORM
*IMPORTANT*
You Must Select ONE Of the Four Options and Follow the Instructions Below. Failure to
do so may result in your forfeiting your rights. CHOOSE ONLY ONE
Objection to Settlement - I intend to object to the proposed settlement. The reason for my objection is;
(PLEASE DESCRIBE IN DETAIL YOUR REASON FOR OBJECTING IN THE SPACE BELOW. If you
need more room you may also write on the back.)

Print Your Name: _________________________ Your Signature: __________________________
Your Telephone Number: _____________________
     NOTICE OF INTENTION TO APPEAR.
YES. BY CHECKING THE BOX ABOVE, I REQUEST THAT I BE ALLOWED TO SPEAK AT
THE HEARING ON APPROVAL OF THE SETTLEMENT
If you choose Option 4, please print and sign your name and provide your telephone number. Return this
form in the pre-addressed, stamped envelope provided for your convenience. You must then send your written
objection(s), postmarked no later than ( 45 days from the date of the mailing):In addition to all of the above,
if you wish to be allowed to speak at the hearing on approval of the settlement, you must check the box”
Notice of Intention to Appear.