Brookline Homes, LLC. vs City of Mount Holly

Case No. 19-CVS-1163

Superior Court Division of Gaston County, North Carolina

The deadline for submitting this claim form is December 20, 2020

SECTION A: NAME AND CONTACT INFORMATION

Provide your name and contact information below. It is your responsibility to notify the Settlement Administrator of any changes to your contact information after the submission of your Claim Form.

* Required Fields

Is the address of the affected property different from the contact information address provided above?

SECTION B: INFORMATION ABOUT FEES PAID DURING THE CLASS PERIOD

Provide Responses to all Questions below:

1. On or between March 22, 2016 and June 30, 2018 did you pay System Development Fees to the City as a condition of building a structure in the planning jurisdiction of the City? Question 1:
2. If you answered “YES” to Question 1 above, list the amount of the System Development Fees paid to the City. Your submission does not have to be completely correct to receive the full amount of System Development Fees paid. Mount Holly will verify the correct amount in its records. Question 2:

If you had multiple addresses for which you paid Development Fees click here:

Affected Property Street City State Zip Development Fees Paid
1
2
3
4
5
6
7
8
9

If you have more affected properties than fit in this table please email a spreadsheet of your affected properties to the Settlement Administrator at info@mounthollysettlement.com.

SECTION C: CERTIFICATION STATEMENT FOR ENTIRE CLAIM FORM

CERTIFICATION STATEMENT: I affirm that all information in this Claim Form and supporting documentation provided is true and accurate under penalty of perjury. I understand the Settlement Administrator may contact me to request further verification of information provided on this Claim Form.

Your Claim Form has been submitted successfully.

Please print this page for your records.

Your Claim Details

Submitted Claim ID:
Confirmation Code:
You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
CLAIM INFORMATION
Entity Name
Street Address
City
State
Zip Code
Email Address
Phone Number
Signature
Date

If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at info@mounthollysettlement.com