CLAIM FORM

Kansas Association of Private Investigators, et al v. Mulvihill, et al

In accordance with an Order of the Circuit Court of Cole County, Missouri, any person or company that paid any license fees to the Kansas City, Missouri Board of Police Commissioners during the period between September 29, 1988 and August 30, 2000 for the issuance or renewal of private security licenses is entitled to a refund of all license fees paid during that period. In order to receive a refund, the person or company that paid such license fees must complete this form and submit it prior to October 31, 2002. Failure to submit a written claim form on or before October 31, 2002 will result in your claim being forever barred.

CLAIMANT INFORMATION:





Claimant Name:_____________________MAIL OR HAND DELIVER THIS
Address:___________________________FORM, ALONG WITH ALL
___________________________________SUPPORTING DOCUMENTS, TO
___________________________________BOPC, PRIVATE OFFICER LICENSING
Daytime Tel No:____________________SECTION, 1328 A GNES,
Contact Person:____________________KANSAS CITY, MISSOURI, 64127









LICENSEE INFORMATION:
(If different than Claimant)		FOR BOPC USE ONLY
Claimant Name:_____________________RECEIVED ON:__________
Address:___________________________
___________________________________DISPOSITION
___________________________________   APPROVED_____
Amounts of Fees Paid and Approx Dates of Payment:
(Attach separate sheets if claiming for multiple licenses)		   REJECTED_____
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
TOTAL AMOUNT APPROVED:
__________
TOTAL AMOUNT OF REFUND CLAIMED:
______________		DISPOSITION NOTICE SENT ON:
____________________

I hereby certify on behalf of the Claimant that the above information and all supporting documentation is true and correct to the best of my knowledge and belief.

Printed Name:
Title:
Date:

FOR FURTHER INFORMATION, YOU MAY CALL THE PRIVATE OFFICER LICENSING SECTION AT (816) 231-5663, OR THE ATTORNEY FOR THE PLAINTIFF CLASS, DOUGLAS S. STONE, AT (816) 753-1000. REJECTED CLAIMS ARE SUBJECT TO REVIEW BY THE COURT.