Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Save to My Library
Look up keyword
Like this
0Activity
0 of .
Results for:
No results containing your search query
P. 1
DirectFilingShortFormpdf-3

DirectFilingShortFormpdf-3

Ratings: (0)|Views: 1 |Likes:
Published by Jude Thomas Smith
DirectFilingShortForm
DirectFilingShortForm

More info:

Published by: Jude Thomas Smith on Aug 07, 2013
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

08/07/2013

pdf

text

original

 
IN RE: OIL SPILL by “Deepwater Horizon”DIRECT FILING SHORT FORM 1
Authorized by Order of the Court, Civil Action No. 10 md 2179 Rec. Doc. 982
(Copies of said Order having also been filed in Civil Actions No. 10-8888 and 10-2771)
MDL2179SECTION:JJUDGECARLBARBIER
CLAIM IN LIMITATION--JOINDER IN MASTER ANSWER--INTERVENTION AND JOINDER IN MASTER COMPLAINTS – PLAINTIFF/CLAIMANT PROFILE FORM
By submitting this document, I am asserting a claim in Complai
nt and Petition of Triton Asset Leasing GmbH, et al 
., No. 10-2771; adopt andincorporate the Master Answer [Rec. Doc. 244] to the Complaint and Petition of Triton Asset Leasing Gmbh, et al., in No. 10-2771; and/or interveneinto, join and otherwise adopt the Master Complaint [Rec. Doc. 879] for private economic losses (“B1 Bundle”) filed in MDL No. 2179 (10 md 2179);and/or intervene into, join and otherwise adopt the Master Complaint [Rec. Doc. 881] for post-explosion injuries (“B3 Bundle”) filed in MDL No. 2179(10 md 2179).
Last NameFirst NameMiddle Name/MaidenSuffixPhone Number 
8
E-mail Address AdressCity / State / Zip
INDIVIDUAL CLAIMBUSINESS CLAIM
Employer NameBusiness NameJob Title/DescriptionType of Business AddressAddressCity / State / ZipCity / State / Zip
 
Last 4 digits of your Social Security NumberLast 4 digits of your Tax ID Numbe Attorney Name
Peter Snyder 
Firm Name
PETER J. SNYDER, P.A.
 Address
2234 North Federal Highway #490
City / State / Zip
Boca Raton FL 33431
Phone Number 
(561) 367-1581
E-mail Address
peterjsnyder@comcast.net
Claim filed with BP?
YESNO
If yes, BP Claim No.:
Claim Filed with GCCF?:
YESNO
If yes, Claimant Identification No.:
ClaimType(Pleasecheckallthatapply):
Damage or destruction to real or personal propertyEarnings/Profit LossPersonal Injury/DeathFear of Future Injury and/or Medical MonitoringLoss of Subsistence use of Natural ResourcesRemoval and/or clean-up costsOther:_____________________________________ 
1ThisformshouldbefiledwiththeU.S.DistrictCourtfortheEasternDistrictofLouisiana,500PoydrasStreet,NewOrleans,Louisiana70130,inCivilActionNo.
ϭϬͲϴϴϴϴ͘tŚŝůĞƚŚŝƐŝƌĞĐƚ&ŝůŝŶŐ^ŚŽƌƚ&ŽƌŵŝƐƚŽďĞĨŝůĞĚŝŶEŽ͘ϭϬͲϴϴϴϴ͕ďLJƉƌŝŽƌŽƌĚĞƌŽĨƚŚĞŽƵƌƚ͕;ZĞĐ͘ŽĐ͘Ϯϰϲ͕͘͘EŽ͘ϭϬͲϮϳϳϭĂŶĚZĞĐ͘ŽĐ͘ϵϴϮŝŶD>ϮϭϳϵͿ͕ƚŚĞĨŝůŝŶŐŽĨƚŚŝƐĨŽƌŵŝŶ͘͘EŽ͘ϭϬͲϴϴϴϴƐŚĂůůďĞĚĞĞŵĞĚƚŽďĞƐŝŵƵůƚĂŶĞŽƵƐůLJĨŝůĞĚŝŶ͘͘ϭϬͲϮϳϳϭĂŶĚD>Ϯϭϳϵ͘WůĂŝŶƚŝĨĨ>ŝĂŝƐŽŶŽƵŶƐĞů͕ĂĨƚĞƌďĞŝŶŐ
notified electronically by the Clerk of Court of the filing of this Short Form, shall promptly serve this form through the Lexis Nexis service system on Defense Liaison.
The filing of this Direct Filing Short Form shall also serve in lieu of the requirement of a Plaintiff to file a Plaintiff Profile Form.
1
 
Brief Description:
1.For earnings/profit loss, property damage and loss of subsistence use claims, describe the nature of the injury. For claims involving realestate/property, include the property location, type of property (residential/commercial), and whether physicaldamage occurred. For claims relatingto fishing of any type, include the type and location of fishing grounds at issue.
SEE ATTACHED LETTER
2.For personal injury claims, describe the injury, how and when it was sustained, and identify all health care providers andemployers 2008 to present and complete authorization forms for each.3.For post-explosion claims related to clean-up or removal, include your role in the clean-up activities, the name of your employer, and where you were working.
The filing of this Direct Filing Short Form shall also serve in lieu of the requirement of a Plaintiff to file a Plaintiff Profile Form.
2

You're Reading a Free Preview

Download
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->