Hernandez v. Mitad del Mundo Bar Restaurant Corp. et al

Filing 12

ORDER granting 11 Motion to Certify FLSA Collective Action. The Proposed Order, at 12 , is so-ordered, with the modifications to Exhibits A and B (correcting the courthouse address and adjusting the Notice date to May) as reflected in the attachments hereto. Ordered by Magistrate Judge Peggy Kuo on 5/6/2016. (Attachments: # 1 Exhibit A, # 2 Exhibit B) (Feldman, Shira)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF NEW YORK
Vilma “Carolina” Hernandez and
Mary Cruz Garcia, on behalf of
themselves and all other persons
similarly situated,

DOCKET NO. 15-CV-6571
(MKB) (PK)

Plaintiffs,
- vs. –
Mitad del Mundo Bar Restaurant
Corp., Segundo Minchala, and
John Does #1-10,

CONSENT TO JOIN COLLECTIVE
ACTION AND BECOME A PARTY
PLAINTIFF

Defendants.

By my signature below, I hereby authorize the filing and prosecution of the above styled Fair
Labor Standards Act action in my name and on my behalf by the representative plaintiffs Vilma
Hernandez and Mary Cruz Garcia as my agents to make decisions on my behalf concerning the
litigation, the method and manner of conducting this litigation and all other matters pertaining to
this lawsuit. By joining, I understand that I will be bound by any judgment of the court or
Settlement of this action. I understand that I will be represented by Samuel & Stein without
prepayment of costs or attorneys’ fees. I understand that if plaintiffs are successful, costs
expended by attorneys on my behalf will be deducted from my settlement or judgment first. I
understand that my attorneys may petition the court for an award of fees and costs to be paid by
defendants on my behalf. I understand that the fees retained by the attorneys will be the amount
received from the defendants, approximately 1/3 of my total settlement or judgment (including
fees), whichever is greater, or such other amount as approved by the Court.

Printed Name

Signature

Date Signed
_________________________

(Street Address)

(City, State, Zip Code)

(Email address)
_________________________

Telephone

Job title/Position

Approximate Dates of Employment

PLEASE RETURN THIS FORM IN TIME FOR FILING WITH THE COURT BY [60 days] to:

MITAD DEL MUNDO COLLECTIVE ACTION
C/O SAMUEL & STEIN
38 West 32nd Street, Suite 1110
New York, NY 10001
If your address or telephone number changes after you have submitted this form, please notify
SAMUEL & STEIN immediately at 212-563-9884 or [e-mail].