Holman v. Experian Information Solutions, Inc. et al

Filing 257

ORDER by Judge Claudia Wilken PRELIMINARILY APPROVING #242 CLASS ACTION SETTLEMENT, DIRECTING NOTICE TO THE CLASS AND SETTING HEARING FOR FINAL APPROVAL OF SETTLEMENT. (Attachments: #1 Notice, #2 Claim Form) (ndr, COURT STAFF) (Filed on 4/29/2014)

CLAIM FORM

Holman v. Experian Information Solutions, Inc.
Notice Administrator
c/o [SETTLEMENT ADMINISTRATOR]
P.O. Box XXXXX
City, ST XXXXX-XXXX

EIH

Name/Address Changes (if any):
First Name

*100002601*
Control #: EIH-«ClaimID» «MailRec»
«First1» «Last1»
«co»
«Addr1» «Addr2»
«City», «ST» «Zip» «Country»

Last Name

Address
,
City

State

Zip

Fill out this whole form. Please fold the completed form so the mailing address is showing, staple or tape it shut, and return it to the
Settlement Administrator. You do not need to put the form in an envelope or put a stamp on the form.
You must fill out and return this form by Month 00, 2014
This form will be used to decide if you should receive a Cash Award. Only claimants who return filled-out, signed forms, postmarked on
or before ___________, 2014, may be eligible for the Cash Award. You must answer the following three questions and provide
information asked for below.
The fact that you have received this notice does not mean that you are a member of the class, which is described in the Notice that is
included with this Claim Form, or that you will get money. IT IS IMPORTANT THAT YOU READ THE NOTICE CAREFULLY BEFORE
YOU COMPLETE THIS CLAIM FORM.
1.

Did you own a car, truck or other vehicle that was towed between 2006 and 2010 that you did not get back?
Circle YES
or
NO.
YES

2.

Did you ask to have your vehicle towed? For example, did you ask the police or a car club, like the AAA, or a towing company
to tow your car. Circle YES
or
NO.
YES

3.

NO

NO

Did a court order you to pay towing charges? Circle YES
YES

or

NO.

NO

Identity Verification: In order to confirm your identity, please provide ONLY ONE of the following two pieces of information:
Last four digits of your Social Security Number: _ _ _ _
OR
Month and Year of your birth (mm/yy): _ _ / _ _
I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct.
Date: _______________________

Signature: ___________________________________

If we need to get in touch with you, please give us the best way to do so (phone, email address, etc.): _________________
__________________________________________________________________________________________________
Questions? Call 1-000-000-0000 or go to www.____.com.

MLT_POC_121114_rev1