Class Action Claim Form PDF Details

Engaging with the Class Action Claim form requires attention to several crucial aspects for those impacted by the Edna Mahan Correctional Facility for Women class action settlement. This form serves as a gateway for claimants to seek compensation through a structured settlement process outlined by the Superior Court of New Jersey, Hunterdon County. It mandates the submission of personal information, including details about the duration of incarceration at the facility since January 1, 2014, and provides a structured approach for selecting compensation tiers ranging from $1,000 to up to $250,000 based on the nature and severity of the claim—ranging from incarceration duration to experiences of sexual harassment or abuse. Additionally, it emphasizes the importance of a timely submission, with a strict deadline set for October 29, 2021, to avoid forfeiture of any compensation while remaining bound to the settlement terms. Options for receiving pro bono assistance from New Jersey law school clinics for those requiring hearings under Tier 2 or Tier 3 further highlight the form's role in guiding claimants through the legal process. Claimants are reminded of the need for thoroughness in completing the form, the necessity of keeping copies for their records, and the responsibility of updating contact information with the settlement administrator. This form is not just a document but a crucial step in seeking justice and compensation for those affected.

QuestionAnswer
Form NameClass Action Claim Form
Form Length2 pages
Fillable?Yes
Fillable fields31
Avg. time to fill out6 min 46 sec
Other namesmcdonald's w2 form 2020, mcdonalds w2 form online, mcdonalds w2 portal, mcdonalds w2 online

Form Preview Example

EMCFW Settlement Administrator c/o Postlethwaite & Netterville P.O. Box 3595

Baton Rouge, LA 70821

Your Claim Form Must Be

Completed and Postmarked On or

Before October 29, 2021

EDNA MAHAN CORRECTIONAL FACILITY FOR WOMEN CLASS ACTION SETTLEMENT

Superior Court of New Jersey, Hunterdon County

CLAIM FORM

FAILURE TO COMPLETE AND RETURN THIS CLAIM FORM BY THE ABOVE DATE WILL RESULT IN A FORFEITURE OF ANY

COMPENSATION AND WILL STILL BIND YOU TO THE SETTLEMENT AND RELEASE.

I. Personal Information

(

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Middle Name

 

 

 

 

 

 

 

 

 

 

 

 

 

Last

 

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Suffix

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name While

 

at Edna

 

Mahan

 

Correctional

 

Facility

 

(If

 

Different)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

 

 

 

 

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

of

 

Birth

 

 

 

 

 

 

 

 

‐

 

 

 

 

 

 

 

 

 

 

 

 

 

Last Four Digits

 

of SSN

 

 

 

 

SBI

Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone

 

Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E-Mail

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing

 

Address:

 

Street

 

Address/P.O.

 

Box

 

(include

 

 

 

Apartment/Suite/Floor

 

 

 

Number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

 

Zip

 

Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Preferred Method of Communication:

 

 

 

 

 

Mail

 

 

 

 

 

E-Mail

 

 

Phone

 

 

Months (to be verified by NJDOC)

 

Months Incarcerated at Edna Mahan Correctional

Facility since

January 1,

 

2014:

 

 

 

 

 

 

 

 

 

II. Tier Selection

Please check the box to indicate which tiered settlement you are claiming and whether you are requesting a hearing (where

applicable). For a complete description of each tier and definition of terms, please refer to the legal notice.

TIER 1

Compensation of $1,000 plus $20 per month (or partial month) incarcerated at Edna Mahan Correctional

 

Facility since January 1, 2014. Selection of this tier does not require any additional documentation, with

 

payment expected by January 27, 2022.

TIER 2

TIER 3

Compensation of up to $4,500 for victims who experienced sexual harassment while incarcerated at Edna Mahan Correctional Facility. Selection of this tier requires a separate affidavit or certification describing the sexual harassment you claim you experienced. Claimants selecting this tier also have the option of submitting contemporaneous corroborating documentation with their claim and requesting a hearing. Payment will be made for claimants in this tier after all Tier 2 and Tier 3 claims have been heard and decided. If no selection is made below, no hearing will be requested.

YES, I would like to request a hearing for my claim

NO, I do not request a hearing for my claim

Compensation of up to $250,000 for victims who experienced sexual abuse while incarcerated at Edna Mahan Correctional Facility. Selection of this tier requires a separate affidavit or certification describing the sexual abuse you claim you experienced plus contemporaneous corroborating documentation. A hearing is mandatory for Tier 3 claims. Payments will be made for claimants in this tier after all Tier 2 and Tier 3 claims have been heard and decided.

EDNA MAHAN CORRECTIONAL FACILITY FOR WOMEN CLASS ACTION SETTLEMENT

Superior Court of New Jersey, Hunterdon County

III. Pro Bono Assistance

For Tier 2 claimants who are requesting a hearing, and Tier 3 claimants who are required to have a hearing, please indicate whether you are interested in receiving assistance from representatives of a New Jersey-based law school clinic in preparing your certification and/or affidavit, collecting supporting documentation, and preparing for your hearing.

YES, I would like assistance. Please have a clinic contact me.

NO, I would not like assistance.

IV. Certification

I certify that the above is true and correct to the best of my knowledge. I understand that if any of the foregoing is willfully false, I am

subject to punishment.

Date

Signature

Printed Name

Reminder Checklist

1.Complete all sections of this Claim Form.

2.Sign and date the Claim Form in Section IV.

3.Keep copies of the completed Claim Form and documentation for your own records.

4.Mail your completed Claim Form to the Settlement Administrator at the address at the top of Page 1 of this Claim Form.

5.It is your responsibility to notify the Settlement Administrator of any changes to your contact information after the submission of your Claim Form. You can contact the Settlement Administrator at 1-844-810-1507 or by email at info@EMCFWsettlement.com

6.Please visit the settlement website at www.EMCFWsettlement.com for more information about this settlement.

How to Edit Class Action Claim Form Online for Free

We chose the most efficient web developers to create our PDF editor. This app will let you complete the mcdonalds w2 portal form without difficulty and won't eat up too much of your energy. This easy-to-follow guide will allow you to get going.

Step 1: The web page includes an orange button stating "Get Form Now". Select it.

Step 2: The instant you access the mcdonalds w2 portal editing page, you will see each of the actions it is possible to take with regards to your template in the top menu.

All of the following segments are what you will need to create to receive the finished PDF document.

mcdonalds w 2 fields to fill out

The software will require you to fill in the TIER, and TIER part.

part 2 to completing mcdonalds w 2

Indicate the crucial information in IV, Certification Reminder, Checklist and Date area.

mcdonalds w 2 IVCertification, ReminderChecklist, and Date blanks to insert

Step 3: Click the button "Done". Your PDF form can be exported. It's possible to save it to your laptop or email it.

Step 4: Try to make as many copies of the file as possible to remain away from possible worries.

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