ClaimFormNumber CLAIM FORM People of the State of Illinois v. United Masonry Builders Group Co., Claim Form This Claim Form must be returned or submitted online by July, 2025 to receive your first payment shortly after July 31, 2025. You may also submit a late Claim Form up until November 3, 2027. Claimant ID:(Required)Name: First Last Address:(Required) Street Address 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:(Required)Email:(Required) Social Security or ITIN:(Required)Please select the Payment Option by which you would like to receive your payment and complete the steps as prompted. YOU MUST COMPLETE THE CLAIM FORM AFTER YOU’VE SELECTED YOUR PAYMENT OPTION. Chosen Payment Method(Required)This field is hidden when viewing the formPayment Token(Required)Signature(Required) I verify that this information is correct and that I waive my right to bring suit as described above and covering the time period set forth above. Date(Required) MM slash DD slash YYYY
