Gunning V. First American Title Insurance Company - Settlement Claim Form printable pdf download

Gunning v. First American Title Insurance Company - Settlement Claim Form

TO PARTICIPATE IN THE CLASS ACTION SETTLEMENT IN GUNNING V. FIRST AMERICAN TITLE INSURANCE

COMPANY AND RECEIVE A MONEY AWARD FOR WHICH YOU MAY BE ELIGIBLE, YOU MUST REVIEW AND SIGN

THIS FORM ATTESTING TO THE FACTS STATED BELOW. THE SIGNED FORM, WITH ANY SUPPORTING

DOCUMENTS YOU ARE ABLE TO LOCATE, MUST BE POSTMARKED NO LATER THAN May 4, 2015 AND MAILED

TO TILGHMAN & CO., P.C., P.O. BOX 12983, BIRMINGHAM, AL 35202. FORMS WITH POSTMARKS AFTER May 4,

2015 WILL NOT BE HONORED. THERE WILL BE NO EXCEPTIONS TO THIS DEADLINE.

Between June 14, 2001, and December 31, 2013, did you purchase either a lender’s or owner’s policy

of title insurance from First American Title Insurance Company in connection with a Kentucky real

estate transaction?

No __________ You are not eligible for a payment from the Gunning Settlement. Stop here.

Yes __________ You may be eligible for a payment from the Gunning Settlement. Please complete the

information below and return to the Claims Administrator.

What is the physical location of the property for which title insurance was purchased?

Street Address:___________________________________________________________________

City: __________________________________________

Is the physical location of the property within the city limits of any city?

No ________ Yes __________; If, Yes which city: _________________

Which county is the physical location of the property in: ____________________

If you have your HUD-1 Settlement Statement(s), list the amount of tax that you paid as listed under

the subheading “Title Charges” in lines 1100 to 1113 and include a copy of the Settlement Statement

with this form. S

UBMIT THIS

LAIM

ORM EVEN IF YOU DO NOT HAVE THIS INFORMATION IF

QUESTION

IS CHECKED YES

$__________ (Title Ins. Tax) and Date of closing __________ (If you have this information)

I hereby affirm under penalty of perjury that the information provided above is true and correct to the best of my knowledge

and belief. I have either included the documents I have supporting the above statement with this claim form or have

undertaken a diligent search to locate those documents and have not been able to find them. I further affirm that I have not

been reimbursed for title insurance premium tax I paid. I understand that by signing this form I release and give up any

claims I might have against First American Title Insurance Company based on the facts asserted in this lawsuit.

Name:_____________________________

Signature:__________________________________

Phone Number: ___________________________________________ Date:____________________

Current Address:_____________________________________________________________________

Name:_____________________________

Signature:__________________________________

Phone Number: ___________________________________________ Date:____________________

Current Address:_____________________________________________________________________

NOTE: TO RECEIVE THE FULL AMOUNT OF ANY BENEFIT UNDER THE SETTLEMENT AGREEMENT, ALL

BORROWERS ON THE LOAN OR OWNERS OF THE REAL PROPERTY MUST SIGN THIS CLAIM FORM.

OTHERWISE ONLY A PROPORTIONAL AMOUNT WILL BE PAID TO THOSE INDIVIDUALS WHO DO SIGN THE

CLAIM FORM.

For More Information, Call 1-800-755-3699 Toll Free.

Gunning V. First American Title Insurance Company - Settlement Claim Form

Related Articles

Related forms

Related Categories