Perry v. AT&T Mobility LLC et al
Filing
96
ORDER by Judge GONZALEZ ROGERS granting 90 Motion for Preliminary Approval of Settlement (lrc, COURT STAFF) (Filed on 1/9/2013) (Additional attachment(s) added on 1/9/2013: # 1 Exhibit, # 2 Exhibit, # 3 Exhibit) (lrc, COURT STAFF).
Exhibit 3 to Order Granting
Preliminary Approval
IN THE UNITED STATES DISTRICT COURT
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NORTHERN DISTRICT OF CALIFORNIA
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SANDRA PERRY, ARMAKIA
MARINER-REED and PATRYCE
COUNTS, individuals, on behalf of
themselves, and on behalf of all persons
similarly situated; and JASON HILTON,
an individual,
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CLAIM FORM
Compl. Filed:
Courtroom:
Judge:
Plaintiffs,
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Case No. C 11-01488 YGR
March 28, 2011
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Hon. Yvonne
Gonzalez Rogers
v.
ARISE VIRTUAL SOLUTIONS INC., a
Delaware Corporation,
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Defendant.
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IF YOU WISH TO RECEIVE YOUR SHARE OF THIS CLASS ACTION
SETTLEMENT: COMPLETE THIS FORM IN ITS ENTIRETY, SIGN THE
FORM, AND RETURN IT VIA FIRST CLASS MAIL TO THE ADDRESS
BELOW WITH A POSTMARK OF NO LATER THAN [DATE] (60 DAYS
AFTER THE CLASS NOTICE AND THIS FORM WAS MAILED).
Gilardi & Co., LLC
P.O. Box 8060
San Rafael, California, 94912-8060
(866) 323-3954
I hereby declare as follows:
(1) I received notice of the proposed Settlement in this action and I wish to receive my
share of the proposed Settlement.
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(2) On one or more occasions from March 28, 2007 through to August 31, 2012, I
provided customer service or technical support services on applications for [AT&T
Mobility LLC accounts / Apple Inc.], while located in the State of California, pursuant
to Statements of Work with Arise Virtual Solutions Inc. (“Arise”).
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CLAIM FORM
C 11-01488 YGR
Exhibit 3 to Order Granting
Preliminary Approval
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(3) Please check only one:
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I agree with Arise’s records that I worked a total of [NUMBER TO BE
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FILLED IN BY CLAIMS ADMINISTRATOR] weeks providing
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customer service or technical support services on applications for [AT&T /
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Apple] accounts, while located in the State of California, pursuant to
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Statements of Work with Arise during the period March 28, 2007 through to
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August 31, 2012. I understand that my share of the Settlement is estimated
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at [$], though this number may increase or decrease without further notice to
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me.
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I disagree with Arise’s records and instead contend, under penalty of
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perjury, that I worked a total of _________ weeks providing customer
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service or technical support services on applications for [AT&T / Apple]
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accounts, while located in the State of California, pursuant to Statements of
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Work with Arise during the period March 28, 2007 through to August 31,
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2012. I have enclosed documents supporting my contention in this regard,
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and understand that the Claims Administrator will determine the validity of
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my contention. PLEASE NOTE: If you disagree with Arise’s records
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you must file your dispute with the Claims Administrator. You should
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not contact Arise.
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I declare that the foregoing and the information provided below is true and correct.
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Executed on ____________(date), 2013, at ____________________________ (city and
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state).
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(Signature)
(Typed or Printed Name)
(Address)
(City, State, Zip Code)
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CLAIM FORM
C 11-01488 YGR
Exhibit 3 to Order Granting
Preliminary Approval
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(Telephone Number, Including Area Code)
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CLAIM FORM
C 11-01488 YGR
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