Change of Address – Chalmers et al v. City of New York

Change of Address Form

Note: If your address has changed, please let the Settlement Administrator know by completing the Change of Address Form.

"*" indicates required fields

First Name*

Last Name*

Last 4 of SSN*

Phone

Address*

Mailing Address APT or STE # City State ZIP Code

Electronic Signature*

Date*

This field is for validation purposes and should be left unchanged.