IMPORTANT: Please complete and sign this claim form if you do not want the $300.00 Voucher for HMI filtration products. ONLINE CLAIM FORMS MUST BE SUBMITTED NO LATER THAN JULY 16, 2019. ClaimFormNoYOUR CURRENT INFORMATIONClaimant ID (found on the Notice of Settlement you received in the mail)*Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail REQUEST FOR $100 CASH AWARDSignature Line* I am a Class Member and elect to receive a payment of $100.00 in lieu of a voucher for HMI filtration products. Please send the check to the address listed above. Unique IDCommentsThis field is for validation purposes and should be left unchanged.