Go to xxx xxxxxxx.xxx
Go to xxx xxx.xxx/XxxxX0 for instructions and the latest information. Give Form to the xxxxxxxxx.Xx not send to the IRS. C') a.l 0m> 0.. c 0 • Ul (cI) .o1: .... 0 0 :::J .... E'Zi ·- 1: Q: ;;::: '(x x(I). tn a.l a.l Cl) 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. Humboldt County Association of Governments 2 Business name/disregarded entity name, if different from above 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes. 0 Individual/sole proprietor or 0 C Corporation 0 S Corporation 0 Partnership 0 Trust/estate single-member LLC 0 Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) "' Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. 0 Other (see instructions) "' Joint Power Aoreement - Local Government Agency 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) 3 Exemption from FATCA reporting code (if any) c (Applies to accounts maintained outside the U.S.) 5 Address (number, street, and apt. or suite no.) See instructions. 000 X Xxxxxx, Xxxxx X Requester's name and address (optional) 6 City, state, and ZIP code Xxxxxx, XX 00000 7 List account number(s) here (optional) •·o/ :11- Taxpayer Identification Number (TIN) Enter youTIN in. the xxx.xx ri te box. !hTIN provided must.match te name given on line 1 to avoid L or backup w1thhold1ng. For md1v1duals, th1s 1s generally your soc1al secunty number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Note:If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. DJJ -OJ -1 I I I I Certification Under penalties of perjury, I certify that:
Go to xxx. 0000xxxxxxxxxxxxxxxxxxx.xxx or call 1-XXX-XXX-XXXX
Go to xxx. XXXXX.xxx for detailed information about the Settlement, including a list of affected Checkers and Rally’s restaurants and the exposure dates for each affected location. [The list should be available on the settlement website, rather than some external site, although the online claim form will have them in dropdown menus.] WHAT IS THIS ABOUT? The lawsuit claims that Checkers was responsible for the Data Breach. Checkers denies all of the claims and says it did not do anything wrong. The Court did not decide in favor of either side. Instead, both sides agreed to a settlement. This Settlement is not an admission of wrongdoing or an indication that any law was violated, and no Court has made such a determination. WHO IS INCLUDED? You are included in the Settlement if you reside in the United States and made a credit, debit or other payment card purchase at any affected Checkers or Rally’s restaurant during the period of the Data Breach (“Settlement Class Members”). WHAT DOES THE SETTLEMENT PROVIDE? The Settlement provides two types of relief to people who submit valid claims. You may submit a claim for either:
Go to xxx. XxxxxxxXxxxxxxxxXX.xxx and click on Careers, then Start the Process to Join. Click the iPad image to start the process. Fill out the New Agent Record Data Input form.
Go to xxx. XxxxxxXxxxxXxxxxxxxXxxxxxxxxx.xxx if you need more information concerning who may submit a claim. ONLINE AT: OR BY MAIL TO: xxx.XxxxxxXxxxxXxxxxxxxXxxxxxxxxx.xxx Copper Press Fittings Settlement
Go to xxx xxxxxxx.xxx and find/write down the weather for tomorrow in your Zip Code. Select another city and write down the weather for tomorrow.
Go to xxx xxxxxxxxxxxxxx.xxx and select the “This Day in History” tab on the top of the page. Look at the right panel and select “What happened on your birthday?” (hint: look for the birthday cake) Using your mouse, left click on the red arrow to find your birthday month and then left click on the date. A major event will be listed in the middle of the page and other events are located in the panel on the left side of the web page. Find/write down an event that happened on the month and day of your birthday.
Go to xxx xxxxxx.xxx and using quotes, Google your name “first-name last-name”. Were there links that referenced information about you? Circle Yes or No. YES NO
Go to xxx xxxxxxxx.xxx Select (press the left button on the mouse) the Get Directions link in the upper left portion of the screen. Use your address as the starting point and enter a destination address of a location you could or would want to visit, (it could be any destination such as Disney World). How many miles will you have to travel? According to Mapquest, how long will it take to drive that distance? Write the information below.
