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).

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Exhibit 3 to Order Granting Preliminary Approval IN THE UNITED STATES DISTRICT COURT 1 2 NORTHERN DISTRICT OF CALIFORNIA 3 4 5 6 7 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, 10 CLAIM FORM Compl. Filed: Courtroom: Judge: Plaintiffs, 8 9 Case No. C 11-01488 YGR March 28, 2011 5 Hon. Yvonne Gonzalez Rogers v. ARISE VIRTUAL SOLUTIONS INC., a Delaware Corporation, 11 12 Defendant. 13 14 15 16 17 18 19 20 21 22 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. 23 24 25 26 27 (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”). 28 -1- CLAIM FORM C 11-01488 YGR Exhibit 3 to Order Granting Preliminary Approval 1 2 (3) Please check only one: ❑ 3 I agree with Arise’s records that I worked a total of [NUMBER TO BE 4 FILLED IN BY CLAIMS ADMINISTRATOR] weeks providing 5 customer service or technical support services on applications for [AT&T / 6 Apple] accounts, while located in the State of California, pursuant to 7 Statements of Work with Arise during the period March 28, 2007 through to 8 August 31, 2012. I understand that my share of the Settlement is estimated 9 at [$], though this number may increase or decrease without further notice to 10 me. ❑ 11 I disagree with Arise’s records and instead contend, under penalty of 12 perjury, that I worked a total of _________ weeks providing customer 13 service or technical support services on applications for [AT&T / Apple] 14 accounts, while located in the State of California, pursuant to Statements of 15 Work with Arise during the period March 28, 2007 through to August 31, 16 2012. I have enclosed documents supporting my contention in this regard, 17 and understand that the Claims Administrator will determine the validity of 18 my contention. PLEASE NOTE: If you disagree with Arise’s records 19 you must file your dispute with the Claims Administrator. You should 20 not contact Arise. 21 I declare that the foregoing and the information provided below is true and correct. 22 Executed on ____________(date), 2013, at ____________________________ (city and 23 state). 24 25 26 (Signature) (Typed or Printed Name) (Address) (City, State, Zip Code) 27 28 -2- CLAIM FORM C 11-01488 YGR Exhibit 3 to Order Granting Preliminary Approval 1 2 (Telephone Number, Including Area Code) 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 -3- CLAIM FORM C 11-01488 YGR

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