1Update Your Information2Select Payment Option Payment Form Number CLAIM FORM People of the State of Illinois v. Greenridge Farm, Inc., Claim Form This Claim Form must be submitted by June 17, 2024 to receive your first payment shortly after July 17, 2024. You may also submit a late Claim Form up until October 20, 2025. Your acceptance of this payment of wages and liquidated damages due under the Fair Labor Standards Act (FLSA), based on the findings of the joint OAG-WHD investigation means that you have given up the right you have to bring suit on your own behalf for the payment of such unpaid minimum wages or unpaid overtime compensation for the period of time from May 24, 2019 to May 24, 2022 and an equal amount in liquidated damages, plus attorney's fees and court costs under Section 16(b) of the FLSA. Claimant ID* Name* First Last 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 Telephone*Email* Social Security or ITIN* Greenridge Payment Option - Step 2Please select the Payment Option by which you would like to receive your payment and complete the steps as prompted. Chosen Payment Method* HiddenPayment Token* Signature* • Yo verifico que esta información es correcta y cedo mi derecho a entablar una demanda para reclamar pago el FLSA de la forma descrita arriba por el periodo de tiempo marcado arriba.
