Step 1 of 7 14% InstagramThis field is for validation purposes and should be left unchanged.This field is hidden when viewing the formhidden claimant id*This field is hidden when viewing the formhidden LastName* Reise, et al. v. City of Calverton Park, et al. Case No. 4:23-cv-01335-SEP CLAIM FORM You are eligible to complete and submit this Claim Form and receive a Settlement Payment if either: you had a vehicle towed by the City of Calverton Park from private residential property for alleged violations of municipal nuisance ordinances between September 15, 2018 and June 26, 2025; or, if you paid a Special Tax Bill (or a nuisance abatement fee) to the City of Calverton Park associated with a vehicle towed from private property for alleged violations of municipal nuisance ordinances between September 15, 2018 and June 26, 2025. Please complete this form in its entirety. Please note that after you submit the form, the settlement administrator may follow up with you for documentation of the information you submit, such as proof of ownership. Claim Forms must be submitted no later than September 4, 2026. Claimant Information:Name: First Last Current Street Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Current Phone Number:*Alternate Phone Number:Email Address: Claimant Verification:Please Check as many boxes as apply:towed and recovered vehicle My vehicle was towed from private residential property by the City of Calverton Park due to an alleged violation of a municipal nuisance ordinance between September 15, 2018 and June 26, 2025, and I recovered that vehicle from the tow lot. towed and did NOT recover vehicle My vehicle was towed from private residential property by the City of Calverton Park due to an alleged violation of a municipal nuisance ordinance between September 15, 2018 and June 26, 2025, and I did not recover that vehicle from the tow lot. paid special tax bill I paid a “Special Tax Bill” (sometimes called a “nuisance abatement fee”) issued by the City of Calverton Park for expenses associated with the towing of a vehicle from private residential property between September 15, 2018 and June 26, 2025, due to an alleged violation of a municipal nuisance ordinance. Potential Tow Class Member Information About Your Towed Vehicle: Please put as much information as you have available to you. If you do not know any piece of information, please leave it blank. Please note that the settlement administrator may follow up after reviewing your claim form to get documentation. Please provide the make, model, year, and VIN of your towed vehicle: Make:Model:Year:VIN (Vehicle Identification Number):Street address from which the vehicle was towed:Were you able to recover this vehicle from the tow lot? Yes No Potential Special Tax Bill Class MemberStreet address from which the vehicle was towed:Approximate Month of Tow:** Select A Month **JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberApproximate Year of Tow: If you know the make, model, and year of the vehicle that was associated with the Special Tax Bill, please provide it below: Make:Model:Year: Cash Payment AwardCash Payment Election* Check here if you wish to receive a cash payment award. At the end of the Claims Period, the available settlement funds will be allocated to Settlement Class Members in each Class who have submitted a valid claims form in the manner explained in the Notice. Claimant DeclarationSignature* I hereby give assurances that the information on this Claim Form is correct. Print Name*Date* MM slash DD slash YYYY CLAIMS MUST BE SUBMITTED BY SEPTEMBER 4, 2026. Call the Settlement Administrator at 1‑800‑792‑1466 if you need assistance or have any questions. ClaimFormNo
