Wis California Wage And Hour Cases San Diego Superior Court printable pdf download

Wis California Wage And Hour Cases San Diego Superior Court

WIS California Wage and Hour Cases

San Diego Superior Court

Case No. 37-2011-00099909-CU-OE-CTL

CLAIM FORM: COMPLETE FOR MONETARY RECOVERY

Please provide address corrections below:

__________________________________________

TO RECEIVE A MONETARY RECOVERY, YOU MUST COMPLETE, SIGN AND

RETURN THIS FORM BY ONE OF THE FOLLOWING (1) FAX, (2) BY FIRST CLASS

U.S. MAIL OR EQUIVALENT, POSTAGE PAID, POSTMARKED; OR (3) THROUGH

THE SETTLEMENT WEBISTE YOU

MUST RETURN THE COMPLETED FORM ON OR BEFORE MAY 18, 2015, TO:

WIS California Wage and Hour Cases

c/o Dahl Administration

P.O. Box 3614

Minneapolis, MN 55403-0614

Facsimile: 1-952-955-4589

YOUR MINIMUM SHARE OF THE SETTLEMENT:

Based on WIS’s records, if the Court approves the Settlement and you properly and timely

submit this Claim Form (and provided you do not “opt-out” of the settlement), you will be

entitled to the following minimum share of the settlement:

 California Claims Class: $___________ based on ______ hours worked as a non-

exempt WIS employee in California between November 14, 2008 and February 1, 2015.

 PAGA Claims Class: $__________ based on ______ hours worked as a non-exempt

WIS employee in California between October 21, 2010 and February 1, 2015.

(This form continues on the reverse side.)

Wis California Wage And Hour Cases San Diego Superior Court