You need to submit this Claim Form to receive compensation under this settlement. If you are a Class Member and you do not timely submit a Claim Form, you will not be eligible for a payment or voucher under this settlement. Unless you timely exclude yourself from the Class by May 12, 2017, you cannot sue the City of Grovetown over the claims settled in this case, even if you do not receive payment or a voucher because your Claim Form was untimely.
This Claim Form asks specific questions about you, the Class Member. Please complete the Claim Form to the best of your ability. If you do not provide the information requested and you do not opt-out of the settlement, you will still be bound by the Settlement Agreement and its release even though you will not be eligible to receive payment or a voucher from the settlement.
Do you currently live within the city limits of Grovetown?
You may skip to the "Class Member Declaration."
Please provide the physical address at which you received water and/or sewer services from the City of Grovetown between September 1, 2011 and September 1, 2016:
Please fill out the following information: