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Wendy's Claim

SETTLEMENT CLAIM FORM

Little v. Wendy's International, LLC

To receive a monetary payment as part of this Settlement, you must timely and validly sign, date, and submit this form. This form must be personally filled out by the Class Member (as defined in the NOTICE) who seeks to participate in the Settlement or someone with a legal right to act on his or her behalf.

This SETTLEMENT CLAIM FORM must be validly completed and submitted by MAY 5, 2025:

I. CERTIFICATION

By signing below, I declare that:

I was employed by Defendant at a Wendy's corporate restaurant in Colorado as a nonexempt restaurant employee during at least one week during the period of October 25, 2014, to February 19, 2025;
I have not opted out of the Settlement Class and understand and agree that, by not opting out of the Settlement, I am releasing the "Released Claims" against the "Released Parties" (as defined in the Settlement Agreement, available at https://WenCOLOSettlement.com/);
I have carefully read and understand this form and the Notice (available at https://WenCOLOSettlement.com/);
I understand and am bound by the Settlement Agreement (available at https://WenCOLOSettlement.com/);

I have full authority to execute this agreement and do so as my own free act and deed. I hereby affirm, under penalty of per jury, that the information I have provided in this Settlement Claim Form is true and correct to the best of my knowledge and this is the only Settlement Claim Form that I have submitted.

Executed on:

Name:

Please provide the last 4 digits of your Social Security Number OR your date of birth:

If Settlement Class Member is under 18 years of age (otherwise leave blank):

Parent/Legal Guardian Name:

Please provide any updated contact information, to the extent there's been any changes to your address below:

Address:

Unit/Apt:

City:

State:

Zip:

If you do not timely and validly complete the SETTLEMENT CLAIM FORM, you will still be bound by the Settlement unless you have opted out of the Settlement as described in section 4 of the NOTICE.

Be sure to make a copy of the signed SETTLEMENT CLAIM FORM for your records. It is your responsibility to keep a current address on file with the Administrator. Please make sure to notify the Administrator of any change of address. The contact information for the Administrator is below.

If you have any further questions with respect to this action or about the NOTICE, you may direct such questions to the Administrator. YOU SHOULD NOT CONTACT THE COURT.

Wendy’s International Settlement

c/o Optime Administration, LLC

PO Box 3206

Brockton, MA 02304

Email: [email protected]

Fax: 781-287-0381

Phone: 844-625-7313

Leave this empty:

Your legal name

Your email address