Brimmer v City of Overland Claim Form - Brimmer v City of Overland

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Claim Form

Refund Due to Special Deterrent Fees paid to the City of Overland

Complete this form if you wish to receive a one-time refund of $80.00 due to your past payment of a Special Deterrent Fee to the City of Overland.

Claimant ID*

Name:*

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I hereby give assurances that the information I am providing is correct.

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Date*

Pursuant to this Settlement, you will receive $80.00 if you are one of the individuals who made a Special Deterrent Fee payment to the City of Overland.

You may email the Class Administrator [email protected] with any questions you have.

CLAIMS MUST BE SUBMITTED BEFORE 180 DAYS FOLLOWING FINAL APPROVAL OF THE SETTLEMENT BY THE COURT.

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Brimmer v City of Overland

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