McClintic v. Lithia Motors, Inc.

Filing 38

ORDER approving class notice and claim form, by Judge Richard A Jones. Attachments: # 1 Exhibit 1 (short-form notice), # 2 Exhibit 2 (Claim or Exclusion Form), # 3 Exhibit 3 (long-form notice). (VE)

Claim or Exclusion Form
McClintic v. Lithia Motors, Inc. Class Action Litigation
No. C11-859RAJ, United States District Court for the Western District of Washington
YOU MUST MAIL THIS FORM SO THAT IT IS POSTMARKED NO LATER THAN SEPTEMBER 14, 2012. Please review a summary of
the Release in the Notice accompanying this Claim or Exclusion Form. A copy of the complete Release can be found on the Settlement
Administrator’s website at www.__________.com and in the Settlement Agreement.
Please type or neatly print the following information. The Settlement Administrator will use this information solely for reviewing your claim.
Name (first, middle, and last):
Residential Street Address:
City, State, Zip Code:
Home Telephone Number:
Cellular Phone Number that Received Text Message(s):
Please complete only one of the following two boxes. If you enter information in both boxes, your response will be invalid, and you will
be deemed to have submitted no response.
If you wish to submit a claim, please provide the following information:
I received ONE

TWO text messages from Lithia. (Circle “ONE” or “TWO”)

I received a second text message from Lithia after I attempted to opt out: YES NO

I certify that the foregoing is true and correct to the best of my knowledge.
Dated:

Signature:

If you do not wish to participate in the settlement, please sign below:
I wish to exclude myself from being a member of the Settlement Class.
Dated:

Signature: