OCR Text |
Show f zllz. z "i Business UniSTAR ; 0 O Datesof; Service plan or PhoneSeijQ -i Do not know 1 j From; (month & year) Q Q To j J Telephone Number ( ) Service Plan You Had: (Select Only One) j ! Name 3 Basic Wire Maintenance Address 3 Linebacker ! ' 3 Linebacker Plus ! 911 E T Business UniSTAR Dates of : 3 Service Plan or 3 Phone Service 3 Do not know ! ! From: (month & year) To j J Telephone Number ( ) Service Plan You Had: (Select Only One) j ! Name - 3 Basic Wire Maintenance ! ! Address Linebacker j ' 3 Linebacker Plus ! j Cty State ?p - gusjness UniSTAR j Dates of : 3 Service Plan or 3 Phone Service -I do not know ' ! From: (month & year) Tpj j I Telephone Number ( f ) Service Plan You Had: (Select Only One) ! Name 3 Basic Wire Maintenance j Address Linebacker j J 3 Linebacker Plus ! i Business UniSTAR i Dates of : 3 Service Plan or 3 Phone Service 3 Do not know ! From: (month & year) To j ; If you are making a claim for any telephone number you listed above which was not billed in your name, please J j identify the number and explain why. ( For example, the bill was in the name of your spouse.) J ft I ! 3. If you know, did you have an inside wire service call from j ! U S WEST Communications under a Service Plan during the Yes : No Do not know j ! period of March 1, 1982 and December 31, 1989? J The undersigned certifies that, to die best of his or her knowledge, information and belief the infonnation supplied is true and coueci J Please mail to; ! j United States District Court for the District of New Mexico ! ! Inside Wire Class Settlement Fund j ! P.O. Box 46528 j ! r Denver, CO 80201-6528 J Signature I - T mmniL . . .. " " ' 11 -i " ' J J If you had more than four phone numbers, attach an additional sheet. If you have questions or want j another claim form, call 1-800-352-2241, (M-F, 9 a.m. to 7 p.m. - Sat. 9 a.m. to 1 p.m., Mountain Time). j L --- - -! i I |