SUBMIT A CLAIM

CLAIM FORM FOR CRESTMONT VILLAGE CLASS ACTION LITIGATION SETTLEMENT

Johnson, et al., v. The Real Property Known as 5638 Selinsky, et al., Cause No. 2017-10307

USE THIS FORM TO MAKE A CLAIM FOR A CASH PAYMENT

The DEADLINE to submit this Claim Form is June 28, 2023

I.GENERAL INSTRUCTIONS

If you resided at The Crestmont Village Apartments at 5638 Selinsky Road, Houston, Texas 77048 – (referred in this document as “Crestmont”), between October 1, 2015 - October 30, 2015, you may be the subject of an ongoing class action, you are a “Class Member” and are be entitled to make a Claim. To make a claim, you must fall in one of the two categories mentioned below:

Registered Tenant: If You are an “identified plaintiff” in the action with cause number 2017-10307 and You lived at the Crestmont Village Apartments on or about October 1, 2015 - October 30, 2015, under a written lease; and you were present on the premises when The City of Houston ordered you to move out of your home due to the uninhabitable conditions of the apartment complex; and You were relocated by the City of Houston; and You suffered loss of belongings because of the uninhabitable conditions and being forced to move out, then you are entitled to receive $1,000.00.

A list of the “identified plaintiffs” can be found here.

Unregistered Tenant: If You lived at the Crestmont Village Apartments on or about October 1, 2015 - October 30, 2015, under a written lease; and you were present on the premises when The City of Houston ordered you to move out of your home due to the uninhabitable conditions of the apartment complex and you were relocated by the City of Houston; and You suffered loss of belongings because of the uninhabitable conditions and being forced to move out, then you are entitled to receive $1,000.00.

As an Unregistered Tenant Class Member, you must submit reasonable documentation demonstrating your qualifications as a tenant, such as a written lease or a past identification or utility bill showing the address of Crestmont, documentation showing the date you evacuated the premises, proof you were relocated into housing provided by The City of Houston, and your lease for the relocation.

You have sixty (60) days from the date you submit your claim to provide proof that you qualify for as a Class Member.

Please note that such cash payment amounts may be increased or reduced depending on how many people submit such claims. Complete information about the Settlement and its benefits, is available at www.CrestmontVillageClassAction.com.

In order for your claim to be considered, you must timely complete and submit this Claim Form. The Claim Form may be completed online at www.CrestmontVillageClassAction.com or by mailing a completed Claim Form to the address below, received or postmarked on or before June 28, 2023. To ensure the accuracy and completeness of your claim, online claim submission is strongly encouraged. If you plan to mail in a Claim Form, please type or legibly print all requested information below, in blue or black ink. Mail your completed Claim Form, including any supporting documentation, by U.S. Mail to: Roxell Richards Law Firm 6420 Richmond Ave., Ste. 135, Houston, TX 77057.

Additionally, please be advised that claims are limited to one (1) claim per household based on the written lease agreement and will be made payable to the person whose signature is on the lease agreement.

II. CLAIMANT INFORMATION

The Settlement Administrator will use this information for all communications regarding this Claim Form and the Settlement. If this information changes prior to distribution of a cash payment, you must notify the Settlement Administrator in writing at the address above.

First Name *

Last Name *

Middle Name *

Mailing Address, Line 1 (Street/P.O. Box) *

Mailing Address Line 2

City *

State *

ZIP Code *

Country *

Email *

III. REGISTERED TENANTS

Checkboxes

CHECK HERE

If You are an identified plaintiff in the action with cause number 2017-10307 and You lived at the Crestmont Village Apartments on or about October 1, 2015 - October 30, 2015, under a written lease; and you were present on the premises when The City of Houston ordered you to move out of your home due to the uninhabitable conditions of the apartment complex; and You were relocated by the City of Houston; and You suffered loss of belongings because of the uninhabitable conditions and being forced to move out. Only one claim can be filed per Household address.

If you completed this Section, please skip to Section VI below (Payment).

IV. UNREGISTERED TENANT

CHECK HERE

CHECK HERE

If You lived at the Crestmont Village Apartments on or about October 1, 2015 - October 30, 2015, under a written lease; and you were present on the premises when The City of Houston ordered you to move out of your home due to the uninhabitable conditions of the apartment complex and you were relocated by the City of Houston; and You suffered loss of belongings because of the uninhabitable conditions and being forced to move out. Only one claim can be filed per Household address.

You can submit a claim under this Section even if you don’t currently hold a copy of your written lease, as long as you were present on the premises when The City of Houston ordered you to move out of your home due to the uninhabitable conditions of the apartment complex and you were relocated by the City of Houston; You suffered loss of belongings because of the uninhabitable conditions and being forced to move out; and You provide additional documentation as required by Section V. Only one claim can be filed per Household address.

If you completed this Section, please continue to Section V below (If You Are and Unregistered Tenant).

V.IF YOU ARE AN UNREGISTERED TENANT

CHECK HERE

If You lived at the Crestmont Village Apartments on or about October 1, 2015 - October 30, 2015, and You do not have a written lease.

If you checked the box in this Section, you will need to complete one of the following: 1.If you lived at Crestmont Village Apartments between October 1, 2015 - October 30, 2015:

a. Please provide the date that you evacuated the Crestmont Village Apartments(Month-Day-Year):

b. Please provide at least one Governmental I.D. (okay if expired) that shows your address as 5638 Selinsky Road, Houston, Texas 77048:

c. You will need to provide reasonable documentation showing the date you evacuated the premises, the date you were relocated into housing provided by The City of Houston, and your lease for the relocation.

2.If You lived at Crestmont Village Apartments between October 1, 2015 - October 30, 2015, but You do not have your written lease or Governmental I.D. that shows your address as 5638 Selinsky Road, Houston, Texas 77048:

a. Please provide the date that you evacuated the Crestmont Village Apartments:(Month-Day-Year)

b. You will need to provide reasonable documentation, such as a utility bill, showing the address of Crestmont Village Apartments (5638 Selinsky Road, Houston, Texas 77048). c. You will need to provide reasonable documentation showing the date you evacuated the premises, were relocated into housing provided by The City of Houston, and your lease for the relocation

In addition, you must (i) sign the attestation in Section VII of this Claim Form, and (ii) submit reasonable documentation (with this Claim Form) demonstrating your relationship with Crestmont Village Apartments, such as correspondence that shows your address as 5638 Selinsky Road, Houston, Texas 77048. If you do not submit such documentation or fail to sign the attestation, your claim will be denied.

VI.PAYMENT

You will receive an email at the email address provided in Section II above after Final Approval prompting you to select how you’d like to be paid. You can receive your payment via a variety of digital options such as digital debit card or PayPal, or you can elect to receive a check.

VII.ATTESTATION (ONLY SIGN IF YOU FILLED OUT SECTION V)

I,_________________________________, declare that I lived at the Crestmont Village Apartments between October 1, 2015 - October 30, 2015 under a written lease and I were present on the premises when The City of Houston ordered me to move out of my home due to the uninhabitable conditions of the apartment complex and I was relocated by the City of Houston and I suffered loss of belongings because of the uninhabitable conditions and being forced to move out.

First Name *

Last Name *

Middle Name *

I declare under penalty of perjury under the laws of Texas and of the United States of America that the foregoing is true and correct.

Executed on

Date / Time *

Date

Time