Step 1 of 2 - Update Your Information 50% PaymentFormNumber Baker, et al v. City of Florissant, Missouri CIVIL ACTION NO. 4:16-cv-1693-RHH (E.D. Mo.) PAYMENT INFORMATION FORM This form must be submitted by April 1, 2024. If you are a Remaining Paid Fines Class Member, you will be eligible for a cash payment as long as the Court approves the Settlement. To receive the cash payment, you must complete and submit the form below by April 1, 2024. You are a Remaining Paid Fines Class Member if you made a payment of fines, costs, and/or fees to the City of Florissant that were assessed without an inquiry into their ability to pay, and who paid such fines, costs, and/or fees, and such payment was not a qualifying payment for the Narrowed Paid Fines Class. Name* First Last Date of Birth*Current Street 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 Phone*Claimant ID* Florissant 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*This field is hidden when viewing the formPayment Token*Signature* I verify the information provided is accurate.
