Thomas, et al. v City of St. Ann Class Action Claim Form THIS CLAIM FORM MUST BE SUBMITTED BY February 28, 2024 You may call the Class Administrator at 1-800-372-8104 with any questions you have.This field is hidden when viewing the formhidden_debtors_classThis field is hidden when viewing the formhidden_conditions_classOur records indicate that you:arrestedfinedClaimFormNoClaimant ID*CLAIMANT INFORMATIONName:* First Last Current Mailing Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Phone:*Email:CLAIMANT DECLARATIONPlease Certify* I hereby give assurances that the information I am providing is correct. Printed Name:CAPTCHAUnique IDEmailThis field is for validation purposes and should be left unchanged.
