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__ __ __ • • •-.••-•--•..•• • uwuwcu i . iu.vu.uuw i reye. a u a <br />PROOF OF CiAlM <br />11111111111111111111111111111111111111111111111111111 <br />12172104 <br />Lehiah Acres Lot Owners Association. Inc. v. Think Simplicity Inc. & Alexander Perovich <br />Case No. 6:16 -CV -00933 <br />In order to make a claim under the settlement you must fill in the following sign and send to the <br />Settlement Administrator by one of the methods stated below: <br />1. You Must Provide Your Contact Information to Receive a $390 Settlement Check by mail: <br />Name of person signing form: <br />Company (if applicable): Indian River County Public Wrk <br />Street Address: <br />City/State/Zip Code.- <br />Contact <br />ode: <br />Contact Telephone Number: <br />Current Fax Number(s): <br />Email address: <br />2. You Must Verify Ownership of the Fax Number(s) Listed in No. 1. <br />"I or my company was the subscriber for the fax number 772-778-9391 for at least same <br />time during the Class Period from April 30, 2015 and February 22, 2017. <br />I make this statement under penalty of perjury." <br />X <br />Authorized Signature <br />Sign above line and print name here: <br />3. You Must Return this Claim Form to the Settlement Administrator by April 22.2017: <br />Mail this Claim Form to: Class-Settlement.com <br />Attn: Simplicity Settlement <br />PO Box 9009 <br />Hicksville, NY 11802-9009 <br />OR <br />(b) Fax this Claim Form to: (888) 894-9253 <br />OR <br />(c) Submit this form electronically at www.class-settlement.com <br />Usemame: 12172104 Password: gopbuynol <br />4 <br />P67 <br />