CLAIM FORM Comcast Set-Top Box Settlement
Comcast Account Number (for Current Subscribers only) W9543 v.03 02.05.2019 Page 3 of 5 03-CA4157 Y AT ... sign, and provide today’s date below. I declare, under penalty of perjury, that (1) I am a member of the Class, (2) I was charged a rental fee for use of one or more ... provided in this Claim Form is true and correct (or true and ... ................
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