Request for Exclusion

BROOKS vs. EITANE EMERALD CORP ET AL.,
King County Superior Court Case No. 16-2-11493-8 SEA

REQUEST FOR EXCLUSION

YOU MUST SUBMIT THIS FORM TO EXCLUDE YOURSELF FROM THE SETTLEMENT

If you exclude yourself, you will receive no money from the settlement. To request exclusion from the settlement, complete this form and submit it no later than July 20, 2017.

(for verification)
(please use your permanent mailing address)
I hereby request that I be excluded from the proposed settlement class in the case of BROOKS vs. EITANE EMERALDCORP ET AL.