Superior Court Of California, Claim Form printable pdf download

Superior Court Of California, Claim Form

Superior Court of California, County of Riverside

Meraz v. Mancha Development Company, et al.

Case No. RIC 1106988

CLAIM FORM

CLAIM FORM INSTRUCTIONS

CPT ID: <<CPT ID>>

Name/Address Changes, if any:

<<Name>>

________________________________________

<<Address1>>

________________________________________

<<Address2>>

________________________________________

<<City>>, <<State>> <<Zip Code>>

________________________________________

Home Number: ( ___ ___ ___ ) ___ ___ ___ - ___ ___ ___ ___

Cell Number: ( ___ ___ ___ ) ___ ___ ___ - ___ ___ ___ ___

(XXX-XX- __ __ __ __)

Please Provide ONLY the Last 4 Digits of

Your Social Security Number

You must sign, date and return the Claim Form by First Class U.S. Mail addressed to the Claims

Administrator or in the enclosed pre-printed envelope postmarked on or before October 12, 2012, to

receive your Settlement Payment described in the enclosed Notice. It is strongly recommended that you

retain proof of your timely mailing until receipt of your Settlement Payment check, should the Settlement

be granted final approval.

If you move or the address shown on the Claim Form is NOT correct, you MUST notify the Claims

Administrator and provide your correct or new address. It is your responsibility to keep a current

address on file with the Claims Administrator to ensure receipt of your Settlement Payment. It is strongly

recommended that you retain proof of such notification.

If you wish to challenge the employment information included in the Claim Form, you must submit your

challenge on or before October 12, 2012, along with this Claim Form. (See, the Class Notice, Section

3(a).)

The Claims Administrator’s mailing address and contact information are as follow:

Mancha Development Class Action Settlement Claims Administrator

CPT Group, Inc.

16630 Aston

Irvine, CA 92606

Toll-free: (888) 875-7692

Fax: (949) 419-3446

DEADLINE TO POSTMARK A CLAIM: OCTOBER 12, 2012

Questions? Call Toll Free (888) 875-7692

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CPT ID: <<CPT ID>>

Superior Court Of California, Claim Form