REQUEST FOR EXCLUSION FROM CLASS ACTION LAWSUIT

Michael Brantley, et. al. v. City of Gretna & Redflex Traffic Systems, Inc.
24th Judicial District Court
Docket No. 760-182

Your Name

First Name

					Middle Name
				
Last Name

Name on Notice of Violation (If Different than Above):

					
					First Name
				
					Middle Name
				
					Last Name

Current Addresss

Address 1

Address 2

Zipcode

City

State

Address Where You Received Notice of Violation:

Same current address

Contact Info:

Phone

Any additional information that you wish to submit:

I hereby request to be excluded from the plaintiff class in the class action lawsuit entitled Michael Brantley, et. al., Individually and on behalf of a Class of Similarly Situated Persons v. City of Gretna & Redflex Traffic Systems, Inc., bearing docket number 760-182 in the 24th Judicial District Court for Jefferson Parish, Louisiana. I understand that by requesting to be excluded from this class action lawsuit, I will NOT be eligible to receive any money that may result from any trial or settlement of this lawsuit, if there is one.

Name

Date

Signature

You can download a PDF version of the opt-out form here