Exclusion From Class Action

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ELECTRONIC REQUEST FOR EXCLUSION FROM CLASS SETTLEMENT

Kurt Casadine ,et al. v. Maxim Healthcare Services, Inc.
Case No. CV-12-10078-DMG-CWx

IF YOU WISH TO BE EXCLUDED FROM THE SETTLEMENT CLASS,
YOU MUST SUBMIT AN EXCLUSION FORM BY AUG 21, 2015


FILING BY MAIL. You may submit a Request for Exclusion by signing, completing, and mailing this Form to the address below. This is not a Claim Form. Do not mail this Exclusion Form if you wish to remain in the settlement class.

    I, First Name (required)

     

    Last Name (required)

    hereby elect to opt out of the class in the above-referenced litigation. I confirm that I have received the Notice of Class Action Settlement and Hearing Date for Court Approval, and the claims procedure in the above-referenced litigation. I have decided NOT to participate in the proposed settlement and I understand that I will not receive any benefit from the Settlement.

    Electronic Signature - Type Your Name (required)

    Any Other Names Used During Employment at Maxim Healthcare Services, Inc.

    Address (required)

    City (required)

    State (required)

    Zip Code (required)

    Phone Number (required)

    Your Email (required)

    Last 4 Digits of your Social Security Number (required)

    Questions? Call (888) 613-5553

    Deadline: Your Exclusion Form must be received by the Settlement Administrator by August 21, 2015, to be excluded from the settlement class.