Exclusion Request Form

Settlement Claim ID Included with your email or postcard notice.

First Name*

Last Name*

Email Address

You must upload a request in writing to exclude yourself from the Settlement. The request must identify the case name, Rivera et al. v. Google, LLC, Case No. 2019-CH-00990 (Cir. Ct. Cook Cty.); state your name and address; be physically hand-signed by you; and must also contain a statement to the effect of: “I hereby request to be excluded from the proposed Settlement Class in Rivera et al. v. Google, LLC, Case No. 2019-CH-00990 (Cir. Ct. Cook Cty.)."