Submit Claim | Appalachian Land Company

PLEASE FILL OUT EACH SECTION OF THE FORM:

Full Name *

Business Name or Additional Name (Optional)

Street Address (Mailing Address) *

Street Address 2

City *

State *

Zip Code *

Email Address (Optional)

Current Phone Number *

* Required Fields

CLASS MEMBER AFFIRMATION:
By submitting this Claim Form and checking the box below, I declare that I am a member of the Settlement Class and that the following statement is true
(ALL boxes must be checked to receive payment):

I affirm I was a lessor on Oil and Gas Lease with EQT Production Company (formerly known as Equitable Production Company), or its predecessors in title, during the period of January 1, 1995 through July 31, 2016, and am a member of the Class as defined in the Class Notice.

I affirm I am NOT any of the following: (1) the United States of America; (2) any Judge or Magistrate presiding over this action or a member of their families; (3) Defendant, its affiliate, predecessor-in-interest, or its respective employee, officer or director; or (4) a potential member of the Class who has been paid or accepted reimbursement for withheld severance taxed during the Class Period (between January 1, 1995 and July 31, 2016).

I declare under penalty of perjury under the laws of the State in which this affirmation is executed and the United States of America that all information provided in this Claim Form is true and correct to the best of my knowledge and belief.

Signature: Date:

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Your Claim Details

Submitted Claim ID:
Confirmation Code:
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CLAIM INFORMATION
Full Name
Business Name
Street Address
City
State
Zip Code
Email Address
Phone Number
Signature
Signature Date
I affirm I was a lessor on Oil and Gas Lease with EQT Production Company (formerly known as Equitable Production Company), or its predecessors in title, during the period of January 1, 1995 through July 31, 2016, and am a member of the class as defined in the class notice.
I affirm I am NOT any of the following: (1) the United States of America; (2) any Judge or Magistrate presiding over this action or a member of their families; (3) Defendant, its affiliate, predecessor-in-interest, or its respective employee, officer or director; or (4) a potential member of the class who has been paid or accepted reimbursement for withheld severance taxed during the Class Period (between January 1, 1995 and July 31, 2016).
I declare under penalty of perjury under the laws of the State in which this affirmation is executed and the United States of America that all information provided in this Claim Form is true and correct to the best of my knowledge and belief.

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

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Appalachian Land Company v. EQT Production Company

Case No. 7:08-cv-139-KKC

United States District Court for the Eastern District of Kentucky

Your Claim Form has been submitted successfully.

A confirmation email listing all your claim information has been sent to the email address you provided in your claim. If you do not receive it within the next 20 minutes, please check your Junk Email folder.