Free Other Notice - District Court of Arizona - Arizona

IN RE ALLSTATE INSURANCE COMPANY FAIR LABOR STANDARDS LITIGATION
United States District Court for the District of Arizona, MDL No. 1541
CONSENT TO JOIN COLLECTIVE ACTION
I, t undersigned, consent to be a party plaintiff in the In Re Allstate Insurance Company Fair Labor Standards Litigation
L No. 1541), in der to seek redress for violations(s) ofthe Fair Labor tan rds Act, pursuant to 29 U.S.C. § 216(b).
7; Kr gag;
Sign your name here Date ..
If would like to receiv - ail confirmation from the plaintiffs’ attorneys that your ·
Coliisldnt to Join form has beie; iged with the Court, provide a non—A1lstate e—mail address: QZ (Z { dll is · L?/l@@f`£· l-ji.
_ Must be postmarked on or before Julv 7. 2006. GSW
{IIIIIIIIIIIIIIIIIIIII||l||1|||||Il|I1|||IIl|I|l|ll||I Claim it _1 9866 Name/Address changes <1¤¤y>:
DSM] Mm 7Â¥l$I I
19119 SarichefLoop gin E. - A ·-*1 {Mir I 7
- rb =%?j¤ — A I
Eagle River, AK 99577-8631 I
if O 7 . ed in - an • M me 2 2 it · l int 1
Area Code Daytime Telepboneiblumbprzifq-4;:4i*‘·" {Area- :,_.:_,.;.,El¥eping Telephone Number

. U
IN RE ALLSTATE INSURANCE COMPANY FAIR LABOR STANDARDS LITIGATION
United States District Court for the District of Arizona, MDL No. 1541
CONSENT TO JOIN COLLECTIVE ACTION
I, the undersigned, consent to be aparty plaintiff in the In Re Allstate Insurance Company Fair Labor Standards Litigation
(l\/ID No. 1541), in o , r seek redress for violations(s) ofthe Fair Lab r St dards Act, pursuant to 29 U.S.C. § 216(b).
. r rnd W7
Sign your name ere Date I
If you would like to receive e-mail continuation from the plaintit`fs’ attorneys that your M
Consent to Join form has been fled with the Court, provide a non-Allstate e—mail address: f l
Must be postmarked on or before July 7, 2006.
Illlllllllllllllllllll|||||l||||Illllllllllllllllllllll Claim #:ALR-112224-3-01 I 2223 Name/Address changes :
Marva Lynette Ross A _
1442 Bluff Frst
San Antonio, TX 7824842630
( gl [0 cgse 2?0%¤<@%;_/ga Document 113-2 Engg QZl2] [2006 Eagg 2 Or 2
Area Code Daytime Telephone Number Area Code Evening Telephone Number

Case 2:03-md-01541-PGR

Document 173-2

Filed 07/21/2006

Page 1 of 2

Case 2:03-md-01541-PGR

Document 173-2

Filed 07/21/2006

Page 2 of 2