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Show r BV 'fc' (Pfcl flt ... in tie States of Arizona, Colorado, Idaho, Montana, New Mexico, Utah and Wyoming, You may be eligible for a refund as a result of a recent settlement To make sure you get the maximum benefit under the terms of of a lawsuit against U S WEST5 Communications formerly the settlement, it is important we get as much information from Mountain Bell). Most former customers who paid for an optional you as possible. Please try to complete the form to the best of inside wire maintenance plan ("Service Plan") at any time your ability. If you cannot recall all of the information, you may between March 1, 1982 and December 31, 1989, may be eligible still return your claim form. for a cash refund. Refunds are equal to 65 of the amount paid ., , , . . . .. ... , . c m , .. .f during that time. Individual refunds may range from $1 up to lf Vou nefd helP ln completing this claim form, have questions, or if $64. By completing and returning this claim form, you may be yu ne;,d fsf.stance from Spanish-speakmg .representative, you eligible to receive a refund for money you paid to the telephone y cal to" '" 1 "800-352-224 1 (vcceTDD) Monday through company. There are a few eligibility rules listed below. Fnday; 9,a " t0, P- srdJ 9 P-m- Mountain T,me F 5 3 or write to Carol Walker, Inside Wire Class Settlement Fund, at Former customers of U S WEST Communications will be p O Box 46529, Denver, Colorado 8020 1 -6529. issued a cash refund in one lump sum. If you are currently . a customer of U S WEST Communications in any of these si necessita una forma en Espanol, por favor llame (gratis) 1 -800-352-224 1 states, you will receive your claim form in the mail. I 1 1 . You must provide the correct telephone number, name and address 4. If you provide incomplete or intentionally false information, your claim for each phone you had at any time between March 1 , 1 982 through may be rejected. If you do not know whether you paid for an inside wire December 31 , 1989. Without this information, we may not be able to maintenance plan or had an inside wire service call, you may still file a locate your telephone records to process your claim(s). claim. As long as you provide the minimum required information (See rule number 1 your claim form will be processed. 2. You must have paid for an inside wire maintenance plan at some time between March 1 , 1 982 and December 31,1 989, in any of the 5. You may not assign (transfer) your claim to another person, following states: Arizona, Colorado, Idaho, Montana, New Mexico, Utah and Wyoming. 6. You must sign this claim form or your claim will not be accepted. 3. If U S WEST provided inside wire repair service pursuant to an inside 7. Claims returned (postmarked) after May 18, 1992, wire maintenance plan during the period March 1 , 1 982 and December will not be accepted. 31,1 989, you are not eligible for a refund. y Q Cut completely around dotted line J Please fill out this Claim Form to the best of your ability. If you do not know all of the information requested, you may still send in a claim form, if you were a customer in any of the aforementioned states. This claim form must be signed. ! 1. Your Name Current Phone No. ( ) , ! 3 ( ! Current Address ! ! City State Zip ! ' 2. Fill in the area code and telephone number, name, address and dates of service for every telephone number you j ! had between March 1 , 1 982 and December 31,1 989, in any of the eligible states listed above, If you know, fill in which ! service plan you had at each place. j j Telephone Number ( ) Service Plan You Had: (Select Only One) j 1 Name f. 3 Basic Wire Maintenance ; 7 Address 3 Linebacker ! 1 City State " 3 Linebacker Plus j I J 1 Business UniSTAR ! p Dates of: :) Service Plan or 3 Phone Ser'Q Donotknow j I ! From: (month & vear) 'O " To: ! |