Long v. The UPS Store, Inc., et al.

Case No. 15-CI-000695

Jefferson Circuit Court, Division Ten

The deadline for submitting this form is May 11, 2021

SECTION A: NAME AND CONTACT INFORMATION OF CLAIMANT

Provide your name and contact information below. It is your responsibility to notify the Claims Administrator of any changes to your contact information after the submission of your Claim Form.

Your information above will be used only for purposes of administering your claim in this class action settlement.

* Required Fields
SECTION B: PURCHASE(S) OF NOTARY SERVICES

I swear under penalty of perjury that I purchased notary services from a The UPS StoreĀ® franchise listed below between February 12, 2010 and July 15, 2016, and that the franchise charged me more than $0.50 for such services on (select one of the following):

WARNING: You have selected to opt out of the proposed settlement. By choosing to opt out you will not receive compensation in this settlement. Please select one of the following:


Qualifying The UPS Store Locations

The UPS Store Number Address City State Zip
830 743 E BROADWAY LOUISVILLE KY 40202
1414 1303 US HWY 127 SOUTH, STE. 402 FRANKFORT KY 40601
1815 4949 OLD BROWNSBORO ROAD LOUISVILLE KY 40222
2058 1945 SCOTTSVILLE ROAD, STE. B-2 BOWLING GREEN KY 42104
2113 3044 BARDSTOWN ROAD LOUISVILLE KY 40205
2352 974 BRECKENRIDGE LN LOUISVILLE KY 40207
2661 9219 US HWY 42 #D PROSPECT KY 40059
2734 2335 BUTTERMILK CROSSING CRESCENT SPRINGS KY 41017
2771 4621 OUTER LOOP LOUISVILLE KY 40219
2799 6407 BARDSTOWN ROAD LOUISVILLE KY 40291
2928 9462 BROWNSBORO ROAD LOUISVILLE KY 40241
2940 2901 RICHMOND ROAD, STE. 130 LEXINGTON KY 40509
2994 2028 S HWY 53, STE. 3 LA GRANGE KY 40031
3027 3070 LAKE CROSS CIR LEXINGTON KY 40513
3095 838 E HIGH STREET LEXINGTON KY 40502
3152 12123 SHELBYVILLE ROAD., STE. 100 LOUISVILLE KY 40243
3169 8459 US HWY 42, STE. F FLORENCE KY 41042
3287 4101 TATES CREEK CENTRE DR., STE. 150 LEXINGTON KY 40517
3324 2220 NICHOLASVILLE ROAD., STE. 110 LEXINGTON KY 40503
3325 18 VILLAGE PLAZA SHELBYVILLE KY 40065
3343 1619 BYPASS ROAD WINCHESTER KY 40391
3398 330 EASTERN BYPASS STE. 1 RICHMOND KY 40475
3420 1355 BARDSTOWN ROAD LOUISVILLE KY 40204
3953 4044 FORT CAMPBELL BLVD HOPKINSVILLE KY 42240
4150 378 DIEDERICH BLVD ASHLAND KY 41101
4301 4145 N MAYO TRAIL PIKEVILLE KY 41501
4693 657 SO HURSTBOURNE PKWY LOUISVILLE KY 40222
4819 1067 NORTH MAIN STREET NICHOLASVILLE KY 40356
4905 632 NORTH 12TH STREET MURRAY KY 42071
5029 BLDG 99, MICHIGAN AVE FORT CAMPBELL KY 42223
5114 120 MARKETPLACE CIRCLE STE. C GEORGETOWN KY 40324
5354 6661 DIXIE HWY, STE. 4 LOUISVILLE KY 40258
5369 3131 S 2ND STREET LOUISVILLE KY 40208
5397 650 S HWY 27, STE. 5 SOMERSET KY 42501
5401 1811 N DIXIE AVE., STE. 104 ELIZABETHTOWN KY 42701
5408 12468 LAGRANGE ROAD LOUISVILLE KY 40245
5481 1890 STAR SHOT PKWY., STE. 170 LEXINGTON KY 40509
5638 760 CAMPBELL LN., STE. 106 BOWLING GREEN KY 42104
5834 2202 US HWY 41 N, UNIT E HENDERSON KY 42420
6123 325 W MAIN STREET. WATERFRONT PLAZA, STE. 150 LOUISVILLE KY 40200
6128 127 GOLD VAULT ROAD FORT KNOX KY 40121
6383 1588 LEESTOWN ROAD., STE. 130 LEXINGTON KY 40511
6437 636 SOUTHTOWN BLVD., STE. 5 OWENSBORO KY 42303

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Confirmation Code:
You will need the Submission Form ID and Confirmation Code shown above to make future edits to your claim. Please print this page for future reference.
If you selected the Opt Out check box, your request to opt out of the proposed settlement has been submitted, and you will not be eligible to receive a voucher(s). You may retract your request by sending an email to info@TheUPSStoreNotarySettlement.com.
FORM INFORMATION
Name
Street Address
City
State
Zip Code
Email Address
Phone Number
Signature
Date

If you have any questions regarding your Form, please provide the Submitted Form ID listed above and email us at info@TheUPSStoreNotarySettlement.com