Submit Claim | The UPS Store Notary Settlement

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.

Name *

Street Address *

City *

State *

Zip Code *

Email Address *

Phone Number

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 Store® 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):

1 occasion

2 occasions

3 or more occasions

ONLY CHECK THIS BOX IF YOU WISH TO OPT OUT OF THE SETTLEMENT AND DO NOT WISH TO SUBMIT A CLAIM. By checking this box and submitting this form to the Claims Administrator, you are deciding to opt out of the proposed settlement, which means you will not relinquish any rights you may have to pursue claims against any Defendant or any third party, but you will also not be eligible to receive any compensation under the terms of the proposed settlement agreement. To be effective, this form must be submitted by you to the Claims Administrator prior to May 11, 2021. You may retract your decision at any time prior to the same date by contacting the Claims Administrator at info@TheUPSStoreNotarySettlement.com

Signature *

Date

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

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

Your Form has been submitted successfully.

Submitted Form ID:
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.
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