Danny Test claim form 2

Step 1 of 2

RELEASE OF YOUR CLAIMS

By signing and timely submitting this Claim Form, you agree to be bound by the terms of the Settlement and to release T-Mobile, and Released Parties as defined in the Notice of Settlement, for any time during the period between March 1, 2021 through December 31, 2021, while you worked and/or trained as an SMB Account Executive for T-Mobile USA, Inc., of and from: any and all state, local, and federal Wage and Hour Claims, which shall include, without limitation, all federal, state, and local claims, demands, liabilities, primary rights, and causes of action relating to any alleged failure to pay any type of straight time, minimum wages, and/or overtime wages, payment for all hours worked, spread of hours, meal and/or rest breaks, keeping records of hours worked or compensation due, timing and method of payments, or any other wages under any federal, state, or local law or regulation or common law, whether known or unknown, all claims for penalties, and liquidated damages, punitive damages, interest, attorneys’ fees, paralegals’ fees, experts’ fees, litigation expenses, restitution, equitable relief, and any other available relief based on the wage and hour claims listed above

CLAIM FORM

CLASS ACTION SETTLEMENT.

If you paid to have a vehicle immobilization device/boot removed by Empire Parking Services, Inc. (“EPS”) within the city of Atlanta, Sandy Spring or Decatur and/or within the counties of Cobb, Dekalb, or Fulton from February 3, 2012, through December 12, 2018, you may be eligible for a payment in this settlement. For complete details of the settlement, please review the Class Action Notice at www.Empireparkingsettlement.com. You may also obtain a Claim Form online at www.Empireparkingsettlement.com.

Please print (or type) clearly in blue or black ink. This Claim Form must be submitted online or mailed and postmarked by September 18, 2024. If you have more than one claim, please submit a separate Claim Form for each of your claims

1. CLASS MEMBER INFORMATION

Name

First Last

Address

Street Address City State Zip Code

Phone Number

2. LOSS/CLAIM INFORMATION

Address Or parking lot where booting occurred:

Address or Parking Lot City

Date of Booting:

License Plate/VIN Number of Booted Vehicle:

PLEASE CERTIFY:

I was in possession or control of a vehicle that was booted

I personally paid to have the boot removed

I paid the following $ to EPS via Credit Card/ cash/ Check select one to have the boot removed

3. DOCUMENTATION

Attach any documents that you have showing:

The Vehicle that was booted by EPS;
The date that the booting occurred;
Where and when the booting occurred;
That you were driving the vehicle that was booted; and
That you made payment to EPS to have the boot removed (i.e., receipts, credit card statements with all other charges and account numbers redacted).

4. SIGN, DATE AND SUBMIT YOUR CLAIM FORM

Pursuant to 28 U.S. code 1746, I certify under penatly of perjury under the laws of the United States of America that I have read this claim form; I believe I am eligible for Class membership; all of the information on this Claim Form is true and correct to the best of my knowledge; I have made a diligent search for the documents described in part 3 above; and I have attached to or enclosed with this Claim Form all documents that I have been able to locate.

Month/Day/Year

Full Name(Required)

Signature(Required)

5. SUBMIT YOUR CLAIM FORM

Claim Forms must be submitted online, emailed or postmarked by September 18, 2024, and mailed to:

EPS Settlement Claims
c/o Atticus Administration, LLC
PO Box 64053
Saint Paul, MN 55164
Email: EmpireParkingSettlement@atticusadmin.com
Website: www.EmpireParkingSettlement.com

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